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Chronic Obstructive Pulmonary Disease Stage and Health-Related Quality of Life

Montserrat Ferrer, MD, MPH; Jordi Alonso, MD, PhD; Josep Morera, MD, PhD; Ramon M. Marrades, MD; Ahmad Khalaf, MD; M. Carmen Aguar, MD, PhD; Vicente Plaza, MD, PhD; Luis Prieto, PhD; and Josep M. Anto, MD, PhD
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for the Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. From Hospital de Badalona Germans Trias i Pujol, Badalona, Spain; Hospital Clinic i Provincial, Institut Municipal d'Investigacio Medica-Hospital del Mar, and Hospital de Vic, Barcelona, Spain; and Hospital la Magdalena, Castellon, Spain. Note: Other members of the Quality of Life Chronic Obstructive Pulmonary Disease Study Group are Joan M. Broquetas, Eduard Monso, Josep Roca, Joan Serra Batlles, Jose A. Fiz, and Josep Izquierdo. Acknowledgments: The authors thank E. Pujol, S. Solsona, C. Soler, N. Soler, and I. Casademunt for their help with data collection. They also thank Marta Pulido, MD. Grant Support: In part by grant 92/0312 from Fondo de Investigacion Sanitaria, grant CIRIT/1995 SGR 00434 from Generalitat de Catalunya, and grant CIRIT/PQS-1996 from Generalitat de Catalunya (Dr. Ferrer). Requests for Reprints: Josep M. Anto, MD, PhD, Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigacio Medica-Hospital del Mar, Carrer del Doctor Aiguader 80, E-08003 Barcelona, Spain. Current Author Addresses: Drs. Ferrer, Alonso, and Prieto: Health Services Research Unit, Institut Municipal d'Investigacio Medica, Carrer del Doctor Aiguader 80, E-08003 Barcelona, Spain.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(12):1072-1079. doi:10.7326/0003-4819-127-12-199712150-00003
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Background: The American Thoracic Society recently recommended that chronic obstructive pulmonary disease be staged on the basis of the percentage of predicted FEV1.

Objective: To examine 1) the relation between the American Thoracic Society system for staging chronic obstructive pulmonary disease and health-related quality of life and 2) the effect of self-reported comorbid conditions on health-related quality of life.

Design: Cross-sectional study.

Setting: Outpatient clinics of respiratory department of four hospitals and one primary health care center in Spain.

Patients: 321 consecutive male patients with chronic obstructive pulmonary disease.

Measurements: Functional respiratory impairment, FEV1, respiratory symptoms, and health-related quality of life. Respiratory symptoms and health-related quality of life were measured by using the Spanish version of the St. George's Respiratory Questionnaire and the Nottingham Health Profile.

Results: Patient scores on the St. George's Respiratory Questionnaire were moderately to strongly associated with disease staging (r = 0.27 to 0.51). Compared with reference values, values for health-related quality of life for patients with stage I disease were substantially higher on the St. George's Respiratory Questionnaire (6 and 34; P < 0.001) and values for impairment were significantly greater in stage I patients with comorbid conditions (19 and 36; P = 0.001). At least one concomitant chronic condition was found in 84% of study patients. Comorbid conditions only partly influenced the observed pattern of deterioration of health-related quality of life with worsening stages of disease.

Conclusion: Staging criteria for chronic obstructive pulmonary disease based on percentage of predicted FEV1 separated groups of patients with varying degrees of impairment in health-related quality of life. Contrary to expectations, even patients with mild disease showed substantially compromised health-related quality of life. Comorbid conditions influenced the relation between chronic obstructive pulmonary disease and health-related quality of life.


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Figure 1.
Mean health-related quality-of-life (HRQL) scores (95% CI) in 321 male patients according to the three consecutive stages of chronic obstructive pulmonary disease and reference values.111

White bars represent reference values; striped bars indicate stage I disease (FEV > 49% of predicted value); bars striped in the other direction indicate stage II disease (FEV 35%-49% of predicted value); and hatched bars represent stage III disease (FEV < 35% of predicted value). Possible scores ranged from 0 (best possible health) to 100 (worst possible health). NHP = Nottingham Health Profile; SGRQ = St. George's Respiratory Questionnaire.

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