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

Impact of Physical Activity

When discussing HRQoL over time in individuals with COPD, it is crucial to consider the role of physical activity. All current international guidelines recommend pulmonary rehabilitation as a central component of therapy for people with COPD.[10,28] The most recent Cochrane Airways Group review found that pulmonary rehabilitation is effective in improving 6MWD and HRQoL, including dyspnea, fatigue, emotional function, and emotional mastery.[29] Current international guidelines also recommend pulmonary rehabilitation for patients with recent AECOPD to prevent recurrence and diminish the previously discussed impact on HRQoL.[30] But how important is physical activity outside of a formal rehabilitation program to HRQoL, pulmonary function and prognosis?

Miravitlles et al.[31] evaluated lung function, HRQoL, functional status and self-reported activity levels of 4574 patients with COPD. They found a direct correlation between daily walking time and HRQoL, but an inverse relationship with anxiety and depression. Anxiety and depression were very common in those that walked less than 30 min daily, less in those that walked 30–60 min and least in those that walked more than 60 min per day. Esteban et al. evaluated 611 patients with all stages of COPD using self-reported activity levels and several HRQoL instruments [SGRQ, Chronic Respiratory Questionnaire, Medical Outcomes Short Form (SF-36)] on two occasions 5 years apart.[32] They defined three levels of physical activity – low (walking <2 h/week); moderate (walking 2–4 h/week); and high (walking >4 h/week). Patients who had low levels of physical activity reported more dyspnea, experienced declining HRQoL, and had more hospital admissions than those with high physical activity. Patients whose physical activity increased over time experienced improved HRQoL regardless of their baseline level of physical activity; those whose physical activity decreased over time experienced decreased HRQoL. The authors concluded that HRQoL could significantly improve with only minor sustained increments in physical activity, even in the absence of structured exercise programs.

Waschki et al.[33] evaluated 137 patients with COPD and 26 patients with nonobstructive chronic bronchitis over a 3-year period. They directly measured physical activity, pulmonary function, muscle mass (fat-free mass) and HRQoL (SGRQ, 6MWD). Energy expenditures (total, activity, and sleeping) were used to calculate a physical activity level (PAL). The findings in this study seem to provide less room for optimism than the studies cited earlier. The levels of physical activity parameters decreased significantly across almost the entire group during the 3 years of follow-up, with no significant differences seen between those with COPD versus those with nonobstructive chronic bronchitis. There were also no significant differences between the various stages of COPD. Overall, PAL decreased in 71% and increased in 29%. Patients with an increase in PAL demonstrated the smallest decline in FEV1 and an improvement in HRQoL. A decrease in PAL was associated with a higher annual decrease in FEV1 and larger decrease in HRQoL. Patients with sustained low PAL experienced no deterioration in HRQoL, but did develop accelerated loss of fat-free mass independent of the level of FEV1. All GOLD stages of COPD were affected, with the number of GOLD stage 1 and 2 patients who became physically very inactive doubling from 15% to 32% over 3 years; even early disease was marked by a significant decline in physical activity over time. The authors state that the decline in physical activity in patients with COPD is 2–4 times greater than is seen in healthy elderly study participants. These findings support recommendations to encourage regular activity for all patients with COPD to minimize progression of exercise intolerance, loss of muscle mass, and hopefully improve HRQoL.