Determinants of Different Dimensions of Disease Severity in Asthma and COPD: Pulmonary Function and Health-Related Quality of Life

doi:10.1378/chest.119.4.1034

Chest

Volume 119, Issue 4, April 2001, Pages 1034-1042

https://doi.org/10.1378/chest.119.4.1034 Get rights and content

Objective

To identify determinants of pulmonary function and health-related quality of life (HRQOL) to better understand disease severity in patients with asthma and COPD.

Design

Observational study.

Setting

Dutch general practice.

Patients

We studied 837 asthma patients and 231 COPD patients.

Results

The association between pulmonary function and HRQOL was poor for asthma (ββ = 0.10) and COPD (ββ = 0.19). Multivariately, in asthma, lower pulmonary function was associated with male gender, region of living, current smoking, use of inhaled short-acting bronchodilators, longer duration of disease, and higher diurnal variation in peak expiratory flow. In COPD, lower pulmonary function was associated with male gender, use of inhaled bronchodilators, more days and nights disturbed by respiratory complaints, not wheezing, and bronchial hyperresponsiveness. Reduced HRQOL was associated most strongly with more days and nights disturbed by respiratory complaints and dyspnea in both asthma and COPD. In asthma, additional associations were found with younger age, lower educational level, region of living, comorbidity, use of inhaled bronchodilators and corticosteroids, wheezing, chronic cough, sputum production, and bronchial hyperresponsiveness. In COPD, lower age, not smoking, chronic cough, and sputum production were associated with reduced HRQOL.

Conclusions

Pulmonary function and HRQOL appear to highlight different aspects of disease severity in asthma and COPD. Therefore, both measures should be taken into account in order to get a complete picture of severity of disease.

Section snippets

Patients

Cross-sectional analyses were performed using the baseline measurements of a longitudinal study examining the course and consequences of asthma and COPD in Dutch general practice. Thirty-one general practitioners from 25 practices in two rural regions in the east and northwest, and one urban region in the west of The Netherlands selected all patients registered with a diagnosis of asthma or COPD. Diagnoses of chronic nonspecific lung disease (including asthma and COPD) recorded in general

Results

A total of 2,047 patients with asthma or COPD met the inclusion criteria of this study. Of these patients, 722 refused to participate. These 722 patients were significantly (p < 0.01) younger (mean age, 43 years) and a higher percentage were male (50%), than the 1,325 patients willing to participate in the study (mean age, 46 years; 44% male). Of the 1,325 patients left, 190 patients (14%) were excluded from the analysis because they either had missing data on pulmonary function (n = 13) or

Discussion

In both asthma and COPD, lower pulmonary function was associated with male gender and use of short-acting inhaled bronchodilators. In asthma, additionally, the most apparent associations were found with current smoking, region of living, longer duration of disease, and higher diurnal variation in PEF. In COPD, additional associations were found with use of long-acting bronchodilators; more days and nights disturbed by respiratory complaints; no history of wheezing; BHR; and, although not

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Chest

Clinical Investigations: AsthmaDeterminants of Different Dimensions of Disease Severity in Asthma and COPD: Pulmonary Function and Health-Related Quality of Life

Objective

Design

Setting

Patients

Results

Conclusions

Section snippets

Patients

Results

Discussion

Chest

Chest

Chest

J Clin Epidemiol

Chest

Chest

Chest

Chest

Chest

J Clin Epidemiol

Respir Med

Am J Med

Diagnosis of asthma and chronic obstructive pulmonary disease in general practice

Br J Gen Pract

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Chronic obstructive pulmonary disease (COPD)

Am J Respir Crit Care Med

Optimal assessment and management of chronic obstructive pulmonary disease (COPD): a consensus statement of the European Respiratory Society

Eur Respir J

Lung function testing: selection of reference values and interpretative strategies

Am Rev Respir Dis

Guidelines for the evaluation of impairment/disability in patients with asthma

Am Rev Respir Dis

Reversible and irreversible airflow obstruction as predictor of overall mortality in asthma and chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Quality-of-life considerations in the treatment of asthma

Pharmacoeconomics

Clinical Investigations: Asthma
Determinants of Different Dimensions of Disease Severity in Asthma and COPD: Pulmonary Function and Health-Related Quality of Life