Quality of Life Research

, Volume 11, Issue 4, pp 329–338 | Cite as

Treatment and quality of life in patients with chronic obstructive pulmonary disease

  • M. MiravitllesEmail author
  • J.L. Alvarez-Sala
  • R. Lamarca
  • M. Ferrer
  • F. Masa
  • H. Verea
  • R. Zalacain
  • C. Murio
  • F. Ros
  • R. Vidal


Treatments administered to patients with chronic obstructive pulmonary disease (COPD), especially when used in multiple combinations, are not free of interactions and side effects that can potentially impair health-related quality of life (HRQL). We studied HRQL and its relationship with treatment in a group of 441 patients with stage II or III COPD (age: 66.6 (SD: 8.3) years; FEV1: 32.4% (SD: 8.1%)) using the St George's Respiratory Questionnaire (SGRQ) and the 12-item short form (SF-12) Health Survey. The most prescribed drugs were ipratropium bromide (87.5%), inhaled corticosteroids (69.4%) and short-acting β-2 agonists (64.9%). Patients with stage III of the disease were receiving more drugs, particularly short-acting β-2 agonists (p = 0.002) and inhaled corticosteroids (p = 0.031). The use of theophyllines was associated with a worse total SGRQ score (β = 4.49; p < 0.001), although this negative association decreased with advanced age. A trend towards worse SGRQ scores was observed with the use of high doses of long-acting β-2 agonists (β = 3.22; p = 0.072). Patients receiving three drugs or more presented worse total SGRQ scores than patients receiving fewer drugs (β = 6.1, p < 0.001; and β = 7.64, p < 0.001, respectively). These findings suggest that the use of multiple drugs in the treatment of patients with COPD is associated with worse total SGRQ scores. The effect of drugs, their dosages and associations with other drugs on HRQL merit further research.

Chronic obstructive pulmonary disease Health-related quality of life St George's Respiratory Questionnaire SF-12 Health Survey Treatment 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mannino DM, Brown C, Giovino GA. Obstructive lung disease deaths in the United States from 1979 through 1993. An analysis using multiple-cause mortality data. Am J Respir Crit Care Med 1997; 156: 814–818.Google Scholar
  2. 2.
    Sobradillo V, Miravitlles M, Gabriel R, et al. Geographical variations in prevalence and underdiagnosis of COPD. Results of the IBERPOC multicentre epidemiological study. Chest 2000; 118: 981–989.Google Scholar
  3. 3.
    Ferrer M, Alonso J, Morera J, et al. Chronic obstructive pulmonary disease stage and health-related quality of life. Ann Intern Med 1997; 127: 1072–1079.Google Scholar
  4. 4.
    Tsukino M, Nishimura K, Ikeda A, Koyama H, Mishima M, Izumi T. Physiologic factors that determine the health-related quality of life in patients with COPD. Chest 1996; 110: 896–903.Google Scholar
  5. 5.
    Jones PW, Bosh TK in association with an international study group. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997; 155: 1283–1289.Google Scholar
  6. 6.
    Celli BR, Snider GL, Heffner J, et al. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152: S77-S120.Google Scholar
  7. 7.
    Roca J, Sanchis A, Agustí-Vidal A, et al. Spirometric reference values from a Mediterranean population. Bull Eur Physiopatol Respir 1986; 22: 271–274.Google Scholar
  8. 8.
    American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies (statement). Am Rev Respir Dis 1991; 144: 1201–1218.Google Scholar
  9. 9.
    Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St George's Respiratory Questionnaire. Am Rev Respir Dis 1992; 145: 1321–1327.Google Scholar
  10. 10.
    Ferrer M, Alonso J, Prieto L, et al. Validity and reliability of the St George's Respiratory Questionnaire after adaptation to a different language and culture: the Spanish example. Eur Respir J 1996; 9: 1160–1166.Google Scholar
  11. 11.
    Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey. Construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34: 220–233.Google Scholar
  12. 12.
    Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999; 54: 581–586.Google Scholar
  13. 13.
    Miravitlles M, Mayordomo C, Artés M, Sánchez-Agudo L, Nicolau F, SegÚ JL on behalf of the EOLO Group. Treatment of chronic obstructive pulmonary disease and its exacerbations in General Practice. Respir Med 1999; 93: 173–179.Google Scholar
  14. 14.
    Jackevicius C, Joyce DP, Kesten S, Chapman KR. Prehospitalization inhaled corticosteroid use in patients with COPD and asthma. Chest 1997; 111: 296–302.Google Scholar
  15. 15.
    Miravitlles M, Murio C, Guerrero T, SegÚ JL. Tratamiento de la bronquitis crónica y la EPOCen Atención Primaria. Arch Bronconeumol 1999: 35: 173–178.Google Scholar
  16. 16.
    Van Andel AE, Reisner C, Menjoge SS, Witek TJ. Analysis of inhaled corticosteroids and oral theophylline use among patients with stable COPD from 1987 to 1995. Chest 1999; 115: 703–707.Google Scholar
  17. 17.
    Jones PW, Quirk FH, Baveystock CM. The St George's Respiratory Questionnaire. Respir Med 1991; 85 (Suppl B): 25–31.Google Scholar
  18. 18.
    Ketelaars CAJ, Schlösser MAG, Mostert R, Huyer Abu-Saad H, Halfens RJG, Wouters EFM. Determinants of health-related quality of life in patients with chronic obstructive pulmonary disease. Thorax 1996; 51: 39–43.Google Scholar
  19. 19.
    Monsó E, Fiz JM, Izquierdo J, et al. Quality of life in severe chronic obstructive pulmonary disease: Correlation with lung and muscle function. Respir Med 1998; 92: 221–227.Google Scholar
  20. 20.
    Okubadejo AA, Jones PW, Wedzicha JA. Quality of life in patients with chronic obstructive pulmonary disease and severe hypoxaemia. Thorax 1996; 51: 44–47.Google Scholar
  21. 21.
    Engström CP, Persson LO, Larsson S, Rydén A, Sullivan M. Functional status and well being in chronic obstructive pulmonary disease with regard to clinical parameters and smoking: A descriptive and comparative study. Thorax 1996; 51: 825–830.Google Scholar
  22. 22.
    Hajiro T, Nishimura K, Tsukino M, Ikeda A, Oga T, Izumi T. A comparison of the level of dyspnea vs disease severity in indicating the health-related quality of life of patients with COPD. Chest 1999; 116: 1632–1637.Google Scholar
  23. 23.
    Osman LM, Godden DJ, Friend JAR, Legge JS, Douglas JG. Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax 1997; 52: 67–71.Google Scholar
  24. 24.
    Van den Boom G, Van Schayck CP, Rutten-Van Mölken MPMH, et al. Active detection of chronic obstructive pulmonary disease and asthma in the general population. Results and economic consequences of the DIMCA program. Am J Respir Crit Care Med 1998; 158: 1730–1738.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • M. Miravitlles
    • 1
    Email author
  • J.L. Alvarez-Sala
    • 2
  • R. Lamarca
    • 3
  • M. Ferrer
    • 3
  • F. Masa
    • 4
  • H. Verea
    • 5
  • R. Zalacain
    • 6
  • C. Murio
    • 7
  • F. Ros
    • 8
  • R. Vidal
    • 1
  1. 1.Servei de PneumologiaHospital General Vall d'HebronBarcelonaSpain
  2. 2.Servicio de NeumologíaHospital Clínico San CarlosMadridSpain
  3. 3.Health Services Research UnitInstitut Municipal d'Investigació MèdicaBarcelonaSpain
  4. 4.Servicio de NeumologíaHospital San Pedro de AlcántaraCáceresSpain
  5. 5.Servicio de NeumologíaHospital Juan CanalejoLa CoruñaSpain
  6. 6.Unidad de Patología RespiratoriaHospital de CrucesBaracaldo (Vizcaya)Spain
  7. 7.Unitat de PneumologiaHospital General de CatalunyaBarcelonaSpain
  8. 8.R&D Department QF BayerBarcelonaSpain

Personalised recommendations