Quality of Life Changes Over Time in Patients With Chronic Obstructive Pulmonary Disease

Gary L. Jones

Disclosures

Curr Opin Pulm Med. 2016;22(2):125-129. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Chronic obstructive pulmonary disease (COPD) is often considered to be a disease in which an inevitable decline in lung function results in increasing dyspnea and deteriorating quality of life. This review summarizes recent data that calls this classic paradigm into question. Studies evaluating the effects of chronic sputum production, physical activity, and inhaled medications on quality of life and prognosis are also discussed.

Recent findings Chronic sputum production and level of dyspnea contribute at least as much to impairment of quality of life and prognosis as does abnormal lung function. An accelerated decline in FEV1 occurs in only half of the patients who develop COPD. Current pharmacotherapy has been shown to moderate disease progression and quality of life, although the effects are lost when inhaled corticosteroids are discontinued. Declining physical activity begins early in the course of COPD, but increasing activity levels result in improved quality of life and a slower decline in lung function.

Summary: Symptoms and activity levels are as important as measuring FEV1 in determining disease severity, quality of life, and prognosis of COPD. Therapies exist that moderate the course of the disease, and small sustained increases in physical activity may slow physical deterioration and improve health-related quality of life.

Introduction

Our understanding of chronic obstructive pulmonary disease (COPD) is in a state of transition, with some of the classic concepts now undergoing modification. To a certain extent, this is because in past years severity of disease was primarily assessed by measuring FEV1 (forced expiratory volume in 1 s), often excluding other parameters, such as symptoms and functional ability. In recent years, it has become evident that this may not be the best way to evaluate the full impact of the disease. It is now recognized that COPD is a complex multisystem disease involving more than just obstruction to airflow. In fact, the degree of airflow obstruction often has poor correlation with symptoms of dyspnea, exercise limitation, and health-related quality of life (HRQoL).[1] Accordingly, increasing attention is being paid to measures other than FEV1 that may give a more complete assessment of HRQoL. This article will attempt to provide an update on recent findings concerning the clinical course and HRQoL of patients with COPD.

The societal impact of COPD is daunting with economic measures being one way to infer some of the consequences of COPD. In the United States, an estimated 15.7 million adults have been told that they have COPD.[2] Patients with COPD on average incur 2.73 times higher direct medical costs than those without COPD, and these costs have increased 38% between 2001 and 2010.[3] It is estimated that direct medical costs because of COPD totaled $32 billion in the United States in 2010, with an additional $4 billion in absenteeism costs.[4] COPD is the sixth largest contributor to the number of years lived with disability.[5] Having COPD increases the likelihood of being unable to be employed (24.3 vs. 5.3%) when compared with adults without COPD,[2] similar to unemployment rates for individuals who have had a stroke.[6] Chronic lower respiratory diseases are listed as the third leading cause of death in the United States, with COPD responsible for more than 95%.[7]

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