Quality of Life Research

, Volume 13, Issue 6, pp 1109–1116

Longitudinal Changes in Health Status Using the Chronic Respiratory Disease Questionnaire and Pulmonary Function in Patients with Stable Chronic Obstructive Pulmonary Disease

  • T. Oga
  • K. Nishimura
  • M. Tsukino
  • T. Hajiro
  • S. Sato
  • A. Ikeda
  • C. Hamada
  • M. Mishima
Article

Abstract

Long-term changes in health status have been less evaluated in patients with chronic obstructive pulmonary disease (COPD), in comparison to the changes in forced expiratory volume in 1 s (FEV1). Accordingly, we examined the clinical course of health status as well as pulmonary function in COPD patients, and investigated the relationship between the change in health status and the change in pulmonary function in a 3-year longitudinal study involving 224 patients with COPD. Health status using the Chronic Respiratory Disease Questionnaire (CRQ) and pulmonary function were measured at baseline and every six months over three years. We used the random effects model for the slopes to estimate the longitudinal changes. A total of 147 patients completed the 3-year study. The dyspnoea, fatigue, and emotional function domains of the CRQ declined slowly but significantly over 3 years (p= 0.001, 0.003, and 0.004, respectively) with a mean decline rate of 0.08/year. This means that it would take about 6 years to reach the minimal important change of 0.5 on the CRQ. The mean decline in post-bronchodilator FEV1 was 60 ml/year. None of the changes in any of the domains of the CRQ were significantly correlated with the changes in pulmonary function. We have found that, in comparison to the decline in pulmonary function, health status evaluated by the CRQ declined significantly but very slowly in three of four domains over three years in patients with COPD. Furthermore, we have demonstrated that there was no significant relationship between the change in health status and the change in pulmonary function.

Chronic obstructive pulmonary disease Chronic Respiratory Disease Questionnaire Health status Pulmonary function 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Celli BR. Standards for the optimal management of COPD: A summary. Chest 1998; 113: S283-287.Google Scholar
  2. 2.
    Wijkstra PJ, Jones PW. Quality of life in patients with chronic obstructive pulmonary disease. Eur Respir Mon 1998; 7: 235-246.Google Scholar
  3. 3.
    Anthonisen NR, Connett JE, Kiley JP, et al. The Lung Health Study Research Group. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: The Lung Health Study. JAMA 1994; 272: 1497-1505.Google Scholar
  4. 4.
    Pauwels RA, Löfdahl C-G, Laitinen LA, et al. The European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. N Engl J Med 1999; 340: 1948-1953.Google Scholar
  5. 5.
    Vestbo J, Sø rensen T, Lange P, et al. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: A randomised controlled trial. Lancet 1999; 353: 1819-1823.Google Scholar
  6. 6.
    Mahler DA, Tomlinson D, Olmstead EM, et al. Changes in dyspnea, health status, and lung function in chronic airway disease. Am J Respir Crit Care Med 1995; 151: 61-65.Google Scholar
  7. 7.
    van Schayck CP, Rutten-van Mölken MPMH, van Doorslaer EKA, et al. Two-year bronchodilator treatment in patients with mild airflow obstruction: Contradictory effects on lung function and quality of life. Chest 1992; 102: 1384-1391.Google Scholar
  8. 8.
    van Schayck CP, Dompeling E, Rutten MPMH, et al. The influence of an inhaled steroid on quality of life in patients with asthma or COPD. Chest 1995; 107: 1199-1205.Google Scholar
  9. 9.
    Spencer S, Calverley PMA, Burge PS, Jones PW on behalf of the ISOLDE Study Group. Health status deterioration in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 163: 122-128.Google Scholar
  10. 10.
    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
  11. 11.
    Ware JE, Sherbourne CD. The MOS 36-item short-from health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992; 30: 473-483.Google Scholar
  12. 12.
    American Thoracic Society-European Respiratory Society Longitudinal Data Analysis Workshop. Am J Respir Crit Care Med 1996; 154: S207-284.Google Scholar
  13. 13.
    Strachan D, Sherrill D. Statistical methods. Eur Respir J 1998; 12: S23-27.Google Scholar
  14. 14.
    Guyatt GH, Berman LB, Townsend M, et al. A measure of quality of life for clinical trials in chronic lung disease. Thorax 1987; 42: 773-778.Google Scholar
  15. 15.
    Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics 1982; 38: 963-974.Google Scholar
  16. 16.
    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: S77-120.Google Scholar
  17. 17.
    Medical Section of the American Lung Association. Standardization of spirometry: 1994 update. Am J Respir Crit Care Med 1994; 152: 1107-1136.Google Scholar
  18. 18.
    Japan Society of Chest Diseases. The predicted values of pulmonary function testing in Japanese. Jpn J Thoracic Dis 1993; 31: Appendix [in Japanese].Google Scholar
  19. 19.
    Hajiro T, Nishimura K, Tsukino M, et al. Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: 785-790.Google Scholar
  20. 20.
    Littell RC, Milliken GA, Stroup WW, Wolfinger RD. SAS System for Mixed Models. Cary, North Carolina: SAS Institute, Inc., 1996.Google Scholar
  21. 21.
    Burge PS, Calverley PMA, Jones PW, et al. on behalf of the ISOLDE study investigators. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: The ISOLDE trial. BMJ 2000; 320: 1297-1303.Google Scholar
  22. 22.
    Guyatt GH, King DR, Feeny DH, et al. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol 1999; 52: 187-192.Google Scholar
  23. 23.
    Jaeschke R, Singer J, Guyatt GH. Measurement of health status: Ascertaining the minimal clinically important difference. Control Clin Trials 1989; 10: 407-415.Google Scholar
  24. 24.
    Jones PW, Quirk FH, Baveystock CM. The St. George's Respiratory Questionnaire. Respir Med 1991; 85(Suppl B): 25-31.Google Scholar
  25. 25.
    Jones PW. Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J 2002; 19: 398-404.Google Scholar
  26. 26.
    Singh SJ, Sodergren SC, Hyland ME, et al. A comparison of three disease-specific and two generic health-status measures to evaluate the outcome of pulmonary rehabilitation in COPD. Respir Med 2001; 95: 71-77.Google Scholar
  27. 27.
    Wedzicha JA, Bestall JC, Garrod R, et al. Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale. Eur Respir J 1998; 12: 363-369.Google Scholar
  28. 28.
    Jones PW. Health status measurement in chronic obstructive pulmonary disease. Thorax 2001; 56: 880-887.Google Scholar
  29. 29.
    Curran D, Bacchi M, Hsu Schmitz SF, et al. Identifying the types of missingness in quality of life data from clinical trials. Stat Med 1998; 17: 739-756.Google Scholar
  30. 30.
    Park T. A comparison of the generalized estimating equation approach with the maximum likelihood approach for repeated measurements. Stat Med 1993; 12: 1723-1732.Google Scholar
  31. 31.
    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
  32. 32.
    van Manen JG, Bindels PJ, Dekker EW, et al. Added value of co-morbidity in predicting health-related quality of life in COPD patients. Respir Med 2001; 95: 496-504.Google Scholar
  33. 33.
    Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: 1418-1422.Google Scholar
  34. 34.
    Janssens JP, Rochat T, Frey JG, et al. Health-related quality of life in patients under long-term oxygen therapy: A home-based descriptive study. Respir Med 1997; 91: 592-602.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • T. Oga
    • 1
  • K. Nishimura
    • 1
  • M. Tsukino
    • 2
  • T. Hajiro
    • 3
  • S. Sato
    • 2
  • A. Ikeda
    • 4
  • C. Hamada
    • 5
  • M. Mishima
    • 2
  1. 1.Respiratory DivisionKyoto-Katsura HospitalKyotoJapan
  2. 2.Department of Respiratory Medicine, Graduate School of MedicineKyoto UniversityKyotoJapan
  3. 3.Department of Pulmonary MedicineKobe Nishi City HospitalKobeJapan
  4. 4.Department of Respiratory DiseaseKobe City General HospitalKobeJapan
  5. 5.Department of Pharmacoepidemiology, School of Public HealthKyoto UniversityKyotoJapan

Personalised recommendations