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

Gary L. Jones


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

In This Article

Relationship Between Symptoms and Forced Expiratory Volume in 1 s

The poor correlation between FEV1 and symptoms is illustrated by the effect of chronic bronchitis on HRQoL. Meek et al.[8] compared smokers with chronic bronchitis but without airflow obstruction to smokers with airflow obstruction but without chronic bronchitis. The bronchitic patients without airflow obstruction reported more symptoms and worse HRQoL than the patients with obstructive lung disease, although there was no difference in physical activity. Similar findings were reported by Martinez et al.[9] although in that study the nonobstructive chronic bronchitis group exhibited worse exercise capacity and were less likely to be working. Recognition that patient symptoms must be factored into assessment and management led to changes in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document,[10] where the score from the COPD Assessment Test or the modified Medical Research Council (mMRC) Dyspnea Scale is added to traditional measures of lung function to categorize the severity of the disease. It is now clear that assessing chronic cough, dyspnea, and sputum production in COPD is important as these symptoms are predictive of exacerbations, decreased ability to be employed, hospitalizations and disease progression.[9,11,12] Strikingly, using the most recent GOLD classification system, mortality is higher in GOLD group B (better lung function, more dyspnea/symptoms) than in GOLD group C (worse lung function, less dyspnea/symptoms).[13]

Complicating the assessment of HRQoL is the observation that the patient's perception of disease severity frequently does not correlate with dyspnea severity. Van der Molen et al.[1] note that 36% of patients who were too dyspneic to leave the house, and 60% of patients who had to stop frequently because of dyspnea when walking on level ground, considered their disease to be mild or moderate. The Hokkaido COPD Cohort Study followed 261 COPD patients for 5 years[14] using the St. George Respiratory Questionnaire (SGRQ) to assess HRQoL. They found that HRQoL improved in 42% even as FEV1 and activity levels declined. Thus, limiting symptom assessment to a general question such as, 'How are you doing?' may lead to an incorrect assessment of the severity and progression of the disease. A qualitative study of patients entering a pulmonary rehabilitation program in the Netherlands noted that often patients ignore the fact that they are ill, conceal their symptoms from others and frequently have incorrect perceptions about their physical abilities.[15]