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Nishimura K, Kusunose M, Sanda R, Mori M, Shibayama A, Nakayasu K. Comparison of Predictive Properties between Tools of Patient-Reported Outcomes: Risk Prediction for Three Future Events in Subjects with COPD. Diagnostics (Basel) 2023; 13:2269. [PMID: 37443664 DOI: 10.3390/diagnostics13132269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures must be evaluated for their discriminatory, evaluative, and predictive properties. However, the predictive capability remains unclear. We aimed to examine the predictive properties of several PRO measures of all-cause mortality, acute exacerbation of chronic obstructive pulmonary disease (COPD), and associated hospitalization. METHODS A total of 122 outpatients with stable COPD were prospectively recruited and completed six self-administered paper questionnaires: the COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Baseline Dyspnea Index (BDI), Dyspnoea-12, Evaluating Respiratory Symptoms in COPD and Hyland Scale at baseline. Cox proportional hazards analyses were conducted to examine the relationships with future outcomes. RESULTS A total of 66 patients experienced exacerbation, 41 were hospitalized, and 18 died. BDI, SGRQ Total and Activity, and CAT and Hyland Scale scores were significantly related to mortality (hazard ratio = 0.777, 1.027, 1.027, 1.077, and 0.951, respectively). The Hyland Scale score had the best predictive ability for PRO measures, but the C index did not reach the level of the most commonly used FEV1. Almost all clinical, physiological, and PRO measurements obtained at baseline were significant predictors of the first exacerbation and the first hospitalization due to it, with a few exceptions. CONCLUSIONS Measurement of health status and the global scale of quality of life as well as some tools to assess breathlessness, were significant predictors of all-cause mortality, but their predictive capacity did not reach that of FEV1. In contrast, almost all baseline measurements were unexpectedly related to exacerbation and associated hospitalization.
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Affiliation(s)
- Koichi Nishimura
- Visiting Researcher, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
- Clinic Nishimura, 4-3 Kohigashi, Kuri-cho, Ayabe 623-0222, Japan
| | - Masaaki Kusunose
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
| | - Ryo Sanda
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
| | - Mio Mori
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
| | - Ayumi Shibayama
- Department of Nursing, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
| | - Kazuhito Nakayasu
- Data Research Section, Kondo P.P. Inc., 17-25, Shimizudani-cho, Tennoujiku, Osaka 543-0011, Japan
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Ikeda M, Oga T, Chen-Yoshikawa TF, Tokuno J, Oto T, Okawa T, Okada Y, Akiba M, Tanaka S, Yamada Y, Yutaka Y, Ohsumi A, Nakajima D, Hamaji M, Isomi M, Chin K, Date H. Patient-reported dyspnea and health predict waitlist mortality in patients waiting for lung transplantation in Japan. Respir Res 2021; 22:116. [PMID: 33882928 PMCID: PMC8061007 DOI: 10.1186/s12931-021-01715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients in Japan is mainly based on the registration order. Hence, scientific evidence for risk stratification regarding waitlist mortality is urgently needed. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation. METHODS We analyzed factors related to waitlist mortality using data of 203 patients who were registered as candidates for lung transplantation from deceased donors. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale, and the health status was determined with St. George's Respiratory Questionnaire (SGRQ). RESULTS Among 197 patients who met the inclusion criteria, the main underlying disease was interstitial lung disease (99 patients). During the median follow-up period of 572 days, 72 patients died and 96 received lung transplantation (69 from deceased donors). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total score were significantly associated with waitlist mortality (p = 0.003 and p < 0.001, respectively) as well as age, interstitial lung disease, arterial partial pressure of carbon dioxide, and forced vital capacity. Multivariable competing risk analyses revealed that the mMRC and SGRQ score were associated with waitlist mortality in addition to age and interstitial lung disease. CONCLUSIONS Both mMRC dyspnea and SGRQ score were significantly associated with waitlist mortality, in addition to other clinical variables such as patients' background, underlying disease, and pulmonary function. Patient-reported dyspnea and health may be measured through multi-dimensional analysis (including subjective perceptions) and for risk stratification regarding waitlist mortality.
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Affiliation(s)
- Masaki Ikeda
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | | | - Junko Tokuno
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Oto
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Tomoyo Okawa
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Miki Akiba
- Division of Organ Transplantation, Tohoku University Hospital, Sendai, Japan
| | - Satona Tanaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Maki Isomi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kotanen P, Kainu A, Brander P, Bergman P, Lehtomäki A, Kreivi HR. Validation of the Finnish severe respiratory insufficiency questionnaire. CLINICAL RESPIRATORY JOURNAL 2020; 14:659-666. [PMID: 32155684 DOI: 10.1111/crj.13181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic respiratory insufficiency impacts patients' lives and reduces quality of life. The Severe Respiratory Insufficiency (SRI) questionnaire examines health-related quality of life and is designed specifically for patients receiving home mechanical ventilation (HMV) for chronic respiratory failure (CRF). OBJECTIVES The aim of this study was to validate the Finnish version of the SRI and study its reproducibility in patients with CRF. METHODS Our 74 patients receiving HMV or long-term oxygen treatment for CRF or both completed the SRI and St George's Respiratory questionnaires (SGRQ) three times (at baseline, and then one week and one month later). Reliability and validity of the questionnaires was analysed with Cronbach's alpha and intraclass correlation coefficient. Patients were prospectively followed up for 5 years, with data collected on their use of hospital services and mortality. RESULTS Cronbach's alpha in the SRI ranged from 0.67 to 0.88 and was >0.7 on all subscales except the "attendant symptoms and sleep". On four subscales, Cronbach's alpha was >0.8, and on the summary scale, 0.95. The SRI showed high correlation with SGRQ. Both tests showed good reproducibility. During the 5-year follow-up, 27 (36%) patients died. CONCLUSIONS The Finnish SRI proved valid, reliable and reproducible. Its psychometric properties were good and similar to those of the original questionnaire and of other validation studies.
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Affiliation(s)
- Petra Kotanen
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Annette Kainu
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland.,Terveystalo Healthcare, Digital Health, Helsinki, Finland
| | - Pirkko Brander
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paula Bergman
- Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Lehtomäki
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Oga T, Windisch W, Handa T, Hirai T, Chin K. Health-related quality of life measurement in patients with chronic respiratory failure. Respir Investig 2018; 56:214-221. [PMID: 29773292 DOI: 10.1016/j.resinv.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/15/2018] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
The improvement of health-related quality of life (HRQL) is an important goal in managing patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) and/or domiciliary noninvasive ventilation (NIV). Two condition-specific HRQL questionnaires have been developed to specifically assess these patients: the Maugeri Respiratory Failure Questionnaire (MRF) and the Severe Respiratory Insufficiency Questionnaire (SRI). The MRF is more advantageous in its ease of completion; conversely, the SRI measures diversified health impairments more multi-dimensionally and discriminatively with greater balance, especially in patients receiving NIV. The SRI is available in many different languages as a result of back-translation and validation processes, and is widely validated for various disorders such as chronic obstructive pulmonary disease, restrictive thoracic disorders, neuromuscular disorders, and obesity hypoventilation syndrome, among others. Dyspnea and psychological status were the main determinants for both questionnaires, while the MRF tended to place more emphasis on activity limitations than SRI. In comparison to existing generic questionnaires such as the Medical Outcomes Study 36-item short form (SF-36) and disease-specific questionnaires such as the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ), both the MRF and the SRI have been shown to be valid and reliable, and have better discriminatory, evaluative, and predictive features than other questionnaires. Thus, in assessing the HRQL of patients with CRF using LTOT and/or NIV, we might consider avoiding the use of the SF-36 or even the SGRQ or CRQ alone and consider using the CRF-specific SRI and MRF in addition to existing generic and/or disease-specific questionnaires.
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Affiliation(s)
- Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54, Kawahara, Shogoin, Sakyo-ku, Kyoto, Japan.
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany.
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54, Kawahara, Shogoin, Sakyo-ku, Kyoto, Japan.
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Tabberer M, Gonzalez-McQuire S, Muellerova H, Briggs AH, Rutten-van Mölken MPMH, Chambers M, Lomas DA. Development of a Conceptual Model of Disease Progression for Use in Economic Modeling of Chronic Obstructive Pulmonary Disease. Med Decis Making 2017; 37:440-452. [PMID: 27486218 DOI: 10.1177/0272989x16662009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To develop and validate a new conceptual model (CM) of chronic obstructive pulmonary disease (COPD) for use in disease progression and economic modeling. The CM identifies and describes qualitative associations between disease attributes, progression and outcomes. METHODS A literature review was performed to identify any published CMs or literature reporting the impact and association of COPD disease attributes with outcomes. After critical analysis of the literature, a Steering Group of experts from the disciplines of health economics, epidemiology and clinical medicine was convened to develop a draft CM, which was refined using a Delphi process. The refined CM was validated by testing for associations between attributes using data from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE). RESULTS Disease progression attributes included in the final CM were history and occurrence of exacerbations, lung function, exercise capacity, signs and symptoms (cough, sputum, dyspnea), cardiovascular disease comorbidities, 'other' comorbidities (including depression), body composition (body mass index), fibrinogen as a biomarker, smoking and demographic characteristics (age, gender). Mortality and health-related quality of life were determined to be the most relevant final outcome measures for this model, intended to be the foundation of an economic model of COPD. CONCLUSION The CM is being used as the foundation for developing a new COPD model of disease progression and to provide a framework for the analysis of patient-level data. The CM is available as a reference for the implementation of further disease progression and economic models.
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Affiliation(s)
- Maggie Tabberer
- Value Evidence and Outcomes, GSK R&D, Stockley Park, UK (MT)
| | - Sebastian Gonzalez-McQuire
- Formerly Global Health Outcomes, GSK R&D, Stockley Park, UK (SGM)
- ICON Health Economics, Morristown, NJ, USA (AHB)
| | | | - Andrew H Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK (AHB)
- ICON Health Economics, Morristown, NJ, USA (AHB)
| | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University/Erasmus Medical Centre, Rotterdam, The Netherlands (MPMHRvM)
| | | | - David A Lomas
- Wolfson Institute for Biomedical Research, University College London, London, UK (DAL)
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Akihiko S, Tomohiro H, Toru O, Kiminobu T, Kohei I, Yoshinari N, Takeshi K, Kumiko K, Kazuo C, Michiaki M. The association between health-related quality of life and disease progression in idiopathic pulmonary fibrosis: a prospective cohort study. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:226-235. [PMID: 32476850 PMCID: PMC7170094 DOI: 10.36141/svdld.v34i3.5214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/24/2017] [Indexed: 12/05/2022]
Abstract
Background and objective: Generally, a disease-specific health-related quality of life (HRQOL) measurement is more useful than generic measures in assessing perceived physical and mental health characteristic of a particular disease. The idiopathic pulmonary fibrosis (IPF)-specific version of St. George’s Respiratory Questionnaire (SGRQ-I) has been recently developed for patients with IPF. We proposed to evaluate associations between the SGRQ-I and other clinical indices, as well as its prognostic value in patients with IPF. Methods: Fifty-two patients with IPF were recruited in this prospective cohort study. HRQOL was assessed using the SGRQ-I and the Medical Outcomes Study 36-item Short Form, dyspnea using the modified Medical Research Council (mMRC) dyspnea scale, and psychological status using the Hospital Anxiety and Depression Scale (HADS). We then evaluated the relationship between the SGRQ-I and other clinical measures, as well as one-year clinical deterioration defined as a hospital admission due to respiratory exacerbation or all-cause death. Results: Stepwise multiple-regression analyses revealed that the mMRC dyspnea scale, the HADS anxiety or depression, and minimum oxygen saturation during a six-minute walk test significantly contributed to the Total and three components of the SGRQ-I. In multivariate Cox proportional-hazards analyses, the Total score of SGRQ-I predicted clinical deterioration independent of forced vital capacity, the six-minute walk distance, or partial pressure of arterial oxygen on room air. Conclusions: The SGRQ-I is a multidisciplinary instrument representing physical, functional and psychological impairments in patients with IPF. The SGRQ-I is a significant predictor of short-term disease progression independent of physiological measurements. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 226-235)
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Affiliation(s)
- Sokai Akihiko
- Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Handa Tomohiro
- Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Oga Toru
- Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tanizawa Kiminobu
- Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ikezoe Kohei
- Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nakatsuka Yoshinari
- Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kubo Takeshi
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kanatani Kumiko
- Health Informatics, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Chin Kazuo
- Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mishima Michiaki
- Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Benzo RP, Abascal-Bolado B, Dulohery MM. Self-management and quality of life in chronic obstructive pulmonary disease (COPD): The mediating effects of positive affect. PATIENT EDUCATION AND COUNSELING 2016; 99:617-623. [PMID: 26632024 PMCID: PMC4808334 DOI: 10.1016/j.pec.2015.10.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/24/2015] [Accepted: 10/31/2015] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study aimed to increase our understanding of general self-management (SM) abilities in COPD by determining if SM can predict disease specific quality of life (QoL), by investigating whether specific SM domains are significant in COPD and by exploring the mediating effect of the positive/negative affect in the association between SM and QoL. METHODS Cross-sectional study based on 292 patients with COPD. Measures included demographics, lung function, gait speed, health care utilization, positive/negative affect, SM abilities, breathlessness and disease specific QoL. We performed, correlation, multiple regression models and mediation analysis (positive/negative affect being mediator between SM and QoL association). RESULTS After controlling for breathlessness, living alone, marital status, hospitalization history, age and lung function, SM related to QoL (p<0.0001). Investment in behaviors (hobbies and social relationships) and self-efficacy are SM domains independently related to QoL in COPD. Positivity measured by the positive/negative affect ratio completely mediates the relationship of SM with QoL. CONCLUSION SM is independently associated with disease specific QoL in COPD after adjustment significant covariates but positive/negative affect ratio completely mediates the relationship of SM with QoL. PRACTICE IMPLICATIONS Measuring positive/negative affect and addressing investment behavior and self-efficacy are important in implementing COPD-SM programs.
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Affiliation(s)
- Roberto P Benzo
- Mindful Breathing Lab, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Beatriz Abascal-Bolado
- Mindful Breathing Lab, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Instituto de Investigación Sanitaria Valdecilla, IDIVAL, Santander, Spain
| | - Megan M Dulohery
- Mindful Breathing Lab, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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8
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Oga T, Taniguchi H, Kita H, Tsuboi T, Tomii K, Ando M, Kojima E, Tomioka H, Taguchi Y, Kaji Y, Maekura R, Hiraga T, Sakai N, Kimura T, Mishima M, Chin K. Analysis of the relationship between health status and mortality in hypercapnic patients with noninvasive ventilation. CLINICAL RESPIRATORY JOURNAL 2015; 11:772-780. [PMID: 26605994 DOI: 10.1111/crj.12415] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 09/13/2015] [Accepted: 11/13/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Toru Oga
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy; Tosei General Hospital; Aichi Japan
| | - Hideo Kita
- Department of Respiratory Medicine; Takatsuki Red Cross Hospital; Osaka Japan
| | - Tomomasa Tsuboi
- Department of Respiratory Medicine; National Hospital Organization Minami-Kyoto Hospital; Kyoto Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine; Kobe City Medical Center General Hospital; Hyogo Japan
| | - Morihide Ando
- Department of Pulmonary Medicine; Ogaki Municipal Hospital; Gifu Japan
| | - Eiji Kojima
- Department of Respiratory Medicine; Komaki City Hospital; Aichi Japan
| | - Hiromi Tomioka
- Department of Respiratory Medicine; Kobe City Medical Center West Hospital; Hyogo Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine; Tenri Hospital; Nara Japan
| | - Yusuke Kaji
- Department of Respiratory Medicine; Tenri Hospital; Nara Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine; National Hospital Organization Toneyama Hospital; Osaka Japan
| | - Toru Hiraga
- Department of Respiratory Medicine; National Hospital Organization Toneyama Hospital; Osaka Japan
| | - Naoki Sakai
- Department of Respiratory Medicine; Otsu Red Cross Hospital; Shiga Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy; Tosei General Hospital; Aichi Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
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French A, Balfe D, Mirocha JM, Falk JA, Mosenifar Z. The inspiratory capacity/total lung capacity ratio as a predictor of survival in an emphysematous phenotype of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:1305-12. [PMID: 26203237 PMCID: PMC4506024 DOI: 10.2147/copd.s76739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Forced expiratory volume in 1 second (FEV1) grades severity of COPD and predicts survival. We hypothesize that the inspiratory capacity/total lung capacity (IC/TLC) ratio, a sensitive measure of static lung hyperinflation, may have a significant association with survival in an emphysematous phenotype of COPD. OBJECTIVES To access the association between IC/TLC and survival in an emphysematous phenotype of COPD. METHODS We performed a retrospective analysis of a large pulmonary function (PF) database with 39,050 entries, from April 1978 to October 2009. Emphysematous COPD was defined as reduced FEV1/forced vital capacity (FVC), increased TLC, and reduced diffusing capacity of the lungs for carbon monoxide (DLCO; beyond 95% confidence intervals [CIs]). We evaluated the association between survival in emphysematous COPD patients and the IC/TLC ratio evaluated both as dichotomous (≤25% vs >25%) and continuous predictors. Five hundred and ninety-six patients had reported death dates. RESULTS Univariate analysis revealed that IC/TLC ≤25% was a significant predictor of death (hazard ratio [HR]: 2.39, P<0.0001). Median survivals were respectively 4.3 (95% CI: 3.8-4.9) and 11.9 years (95% CI: 10.3-13.2). Multivariable analysis revealed age (HR: 1.19, 95% CI: 1.14-1.24), female sex (HR: 0.69, 95% CI: 0.60-0.83), and IC/TLC ≤25% (HR: 1.69, 95% CI: 1.34-2.13) were related to the risk of death. Univariate analysis showed that continuous IC/TLC was associated with death, with an HR of 1.66 (95% CI: 1.52-1.81) for a 10% decrease in IC/TLC. CONCLUSION Adjusting for age and sex, IC/TLC ≤25% is related to increased risk of death, and IC/TLC as a continuum, is a significant predictor of mortality in emphysematous COPD patients.
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Affiliation(s)
- Aimee French
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - David Balfe
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - James M Mirocha
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - Jeremy A Falk
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - Zab Mosenifar
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
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10
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Boutou AK, Tanner RJ, Lord VM, Hogg L, Nolan J, Jefford H, Corner EJ, Falzon C, Lee C, Garrod R, Polkey MI, Hopkinson NS. An evaluation of factors associated with completion and benefit from pulmonary rehabilitation in COPD. BMJ Open Respir Res 2014; 1:e000051. [PMID: 25478193 PMCID: PMC4242085 DOI: 10.1136/bmjresp-2014-000051] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pulmonary Rehabilitation (PR) is an important treatment for patients with chronic obstructive pulmonary disease (COPD) but it is not established whether any baseline parameter can predict response or compliance. AIM To identify whether baseline measures can predict who will complete the programme and who will achieve a clinically significant benefit from a Minimum Clinical Important Difference (MCID) in terms of exercise capacity and health-related quality of life (HRQoL). METHODS Data were collected prospectively from patients with COPD at their baseline assessment for an outpatient PR programme in one of eight centres across London. 'Completion' was defined as attending at least 75% of the designated PR visits and return for the follow-up evaluation. The MCID for outcome measures was based on published data. RESULTS 787 outpatients with COPD (68.1±10.5 years old; 49.6% males) were included. Patients who completed PR (n=449, 57.1%) were significantly older with less severe airflow obstruction, lower anxiety and depression scores, less dyspnoea and better HRQoL. Only baseline CAT score (OR=0.925; 95% CI 0.879 to 0.974; p=0.003) was retained in multivariate analysis. Patients with the lowest baseline walking distance were most likely to achieve the MCID for exercise capacity. No baseline variable could independently predict achievement of an MCID in HRQoL. CONCLUSIONS Patients with better HRQoL are more likely to complete PR while worse baseline exercise performance makes the achievement of a positive MCID in exercise capacity more likely. However, no baseline parameter could predict who would benefit the most in terms of HRQoL.
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Affiliation(s)
- Afroditi K Boutou
- The NIHR Respiratory Biomedical Research Unit , Royal Brompton & Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Rebecca J Tanner
- The NIHR Respiratory Biomedical Research Unit , Royal Brompton & Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Victoria M Lord
- The NIHR Respiratory Biomedical Research Unit , Royal Brompton & Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Lauren Hogg
- Guy's and St Thomas' Foundation NHS Trust , London , UK
| | - Jane Nolan
- St George's Hospital NHS Trust , London , UK
| | - Helen Jefford
- Greenwich Adult Community Health Services, London , UK
| | | | | | | | - Rachel Garrod
- King's College Hospital NHS Foundation Trust , London , UK
| | - Michael I Polkey
- The NIHR Respiratory Biomedical Research Unit , Royal Brompton & Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Nicholas S Hopkinson
- The NIHR Respiratory Biomedical Research Unit , Royal Brompton & Harefield NHS Foundation Trust and Imperial College , London , UK
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Miravitlles M. Health status and costs of exacerbations of chronic bronchitis and COPD: how to improve antibiotic treatment. Expert Rev Pharmacoecon Outcomes Res 2014; 5:423-35. [DOI: 10.1586/14737167.5.4.423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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VAN GESTEL ARNOLDUSJ, KOHLER MALCOLM, STEIER J, TESCHLER SEBASTIAN, RUSSI ERICHW, TESCHLER HELMUT. Cardiac autonomic dysfunction and health-related quality of life in patients with chronic obstructive pulmonary disease. Respirology 2011; 16:939-46. [DOI: 10.1111/j.1440-1843.2011.01992.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Prognostic assessment in COPD: health related quality of life and the BODE index. Respir Med 2011; 105:916-21. [PMID: 21282050 DOI: 10.1016/j.rmed.2011.01.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 01/09/2011] [Accepted: 01/10/2011] [Indexed: 11/23/2022]
Abstract
RATIONALE COPD is a debilitating disease with increasing mortality worldwide. The BODE index evaluates disease severity and the St George's Respiratory Questionnaire (SGRQ) measures health status. OBJECTIVE To identify the relationship between BODE index and the SGRQ and to test the predictive value of both tools against survival. METHODS Open cohort study of 1398 COPD patients (85% male) followed for up to 10 years. MEASUREMENTS AND MAIN RESULTS At the time of the inclusion, clinical data, forced spirometry and 6 min walking distance were determined and BODE index and SGRQ were calculated. Vital status and cause of death were documented at the end of follow-up. RESULTS The cohort's mean of FEV1% predicted was 46 ± 18%, BODE index was 3.6 ± 2.5, and SGRQ% total score was 49 ± 20. The SGRQ scores increased progressively as severity of COPD increased by BODE quartiles. The correlation between SGRQ and BODE index was good (r = 0.58, p < 0.0001). Both tests correlated with COPD survival (BODE = -0.4 vs. SGRQ = -0.20, p < 0.0001). The area under the curve (AUC) for the BODE index was 0.77 vs. 0.66 for the SGRQ % total score (p < 0.001). CONCLUSIONS Health status as measured by SGRQ worsens with disease severity evaluated by the BODE index. Both tools predict mortality and provide complimentary information in the evaluation of patients with COPD.
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[Precipitating factors of mortality in chronic obstructive pulmonary disease patients with frequent exacerbations]. Rev Clin Esp 2010; 210:323-31. [PMID: 20494350 DOI: 10.1016/j.rce.2010.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 01/31/2010] [Accepted: 02/08/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify the main characteristics in patients with COPD exacerbation, capables to predict the short-term COPD mortality. MATERIALS AND METHODS This is a case-control retrospective study of admitted patients with COPD to identify risk factors of mortality. The control group was constituted by alive patients after 6 months. The variables studied were clinical antecedents, comorbility, health and nutritional status, basal dyspnea, dependency, exacerbations, physical examination, pulmonary function, radiology, ECG, microbiology and treatment. Both groups were compared with the Chi-square and the T tests. The predictive capacity was analyzed with logistic regression for which the dependent variable was mortality. RESULTS 125 patients were enrolled (44 exitus and 81 alive) (10 females and 115 males) with mean age of 74+10 years. No significant differences were found between groups in age, sex and disease severity. On the other hand, we found statistically significant differences in basal dyspnea (p<0,01), RCP levels (p<0,007), Hb (p<0,037) and platelets (p<0,041), physic activity (p<0,036), accessory muscles use (p<0,007), positive microbiological culture (p<0,013) and treatment with anticholinergic agents (p<0,029) and digoxin (p<0,039). However, none of these variables was able to predict mortality in the logistic regression analysis. CONCLUSIONS The usual data managed in the follow-up of COPD patients are not useful to identify short-term mortality predictors (6 months) during a hospital admittance. Only some variables that would represent a higher chronic inflammation and a lower exercise tolerance showed a statistical tendence in the dead patients group in a exacerbation of COPD.
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Schünemann HJ, Puhan M, Goldstein R, Jaeschke R, Guyatt GH. Measurement Properties and Interpretability of the Chronic Respiratory Disease Questionnaire (CRQ). COPD 2009; 2:81-9. [PMID: 17136967 DOI: 10.1081/copd-200050651] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The chronic respiratory questionnaire, available as an interviewer and a self-administered instrument, includes 20 items across four domains: dyspnea (5 items), fatigue (4 items), emotional function (7 items), and mastery (4 items). When completing this instrument, patients rate their experience on a 7-point scale ranging from 1 (maximum impairment) to 7 (no impairment). The Chronic Respiratory Questionnaire has demonstrated excellent measurement properties for both discriminative and evaluative purposes and served as a model in numerous methodological studies in chronic airflow limitation and patients with chronic obstructive pulmonary disease. We performed a systematic review of the literature on the chronic respiratory questionnaire to summarize the key qualities of the chronic respiratory questionnaire and to appraise the work regarding the minimal important difference of the chronic respiratory questionnaire. This paper includes a revision of our initial definition of the minimal important difference and a methodological framework for using anchor based approaches to establish the minimal important difference pioneered by Jaeschke and colleagues. Other approaches to evaluate the minimal important difference include distribution-based methods and panel-based methods. Investigators have used all of these approaches to establish the minimal important difference for the chronic respiratory questionnaire and the results are in general agreement with the minimal important difference of 0.5 for the mean domain scores of the chronic respiratory questionnaire. As a result of this literature review and discussion at the workshop, we established several research objectives. These objectives include the exploration of presentation of quality of life information and prospective anchor-based approaches.
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Affiliation(s)
- Holger J Schünemann
- Departments of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, State of New York, Buffalo, New York, USA.
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Predictors of mortality in patients with stable COPD. J Gen Intern Med 2008; 23:1829-34. [PMID: 18795373 PMCID: PMC2585660 DOI: 10.1007/s11606-008-0783-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 11/06/2007] [Accepted: 08/27/2008] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine which easily available clinical factors are associated with mortality in patients with stable COPD and if health-related quality of life (HRQoL) provides additional information. DESIGN Five-year prospective cohort study. SETTING Five outpatient clinics of a teaching hospital. PARTICIPANTS Six hundred stable COPD patients recruited consecutively. MEASUREMENTS The variables were age, FEV(1%), dyspnea, previous hospital admissions and emergency department visits for COPD, pack-years of smoking, comorbidities, body mass index, and HRQoL measured by Saint George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Short-Form 36 (SF-36). Logistic and Cox regression models were used to assess the influence of these variables on mortality and survival. RESULTS FEV(1%)(OR: 0.62, 95% CI 0.5 to 0.75), dyspnea (OR 1.92, 95% CI 1.2 to 3), age (OR 2.41, 95% CI 1.6 to 3.6), previous hospitalization due to COPD exacerbations (OR 1.53, 1.2 to 2) and lifetime pack-years (OR 1.15, 95% CI 1.1 to 1.2) were independently related to respiratory mortality. Similarly, these factors were independently related to all-cause mortality with dyspnea having the strongest association (OR 1.54, 95% CI 1.1 to 2.2). HRQoL was an independent predictor of respiratory and all-cause mortality only when dyspnea was excluded from the models, except scores on the SGRQ were associated with all-cause mortality with dyspnea in the model. CONCLUSIONS Among patients with stable COPD, FEV(1%) was the main predictor of respiratory mortality and dyspnea of all-cause mortality. In general, HRQoL was not related to mortality when dyspnea was taken into account, and CRQ and SGRQ behaved in similar ways regarding mortality.
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Abstract
Although the development of effective treatments for patients with chronic obstructive pulmonary disease (COPD) has not been seen as a high priority, the past decade has seen a substantial increase in the number of clinical studies examining different treatments for this disease. Large studies are needed to adequately assess the effectiveness of treatment because of the chronic nature of the disease and the intermittent occurrence of some key outcomes such as exacerbations. Data from randomised controlled trials show that treatment improves exercise performance by increasing lung volume rather than changing expiratory flow. Although assessment of lung function remains the cornerstone of drug assessment, improvements in health status, the number of exacerbations and admissions to hospital are now recognised as important treatment outcomes. Randomised controlled trial data provide the best evidence for treatment efficacy, but results of these studies can be affected by differences in inclusion criteria and patient dropout during the study. Bronchodilator reversibility testing does not reliably define subgroups that will respond to a particular treatment. Carefully done and adequately powered clinical trials continue to inform, not only our views about treatment, but also our understanding of COPD and how it is best assessed and managed. Ensuring that these expensive studies are done objectively to the highest standard is an important goal for the next decade.
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Affiliation(s)
- Peter M A Calverley
- Division of Infection and Immunity, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
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Oga T, Nishimura K, Tsukino M, Hajiro T, Mishima M. Dyspnoea with activities of daily living versus peak dyspnoea during exercise in male patients with COPD. Respir Med 2005; 100:965-71. [PMID: 16298519 DOI: 10.1016/j.rmed.2005.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 10/02/2005] [Accepted: 10/07/2005] [Indexed: 10/25/2022]
Abstract
Dyspnoea measurements in chronic obstructive pulmonary disease (COPD) can be broadly divided into two categories: those that assess breathlessness during exercise, and those that assess breathlessness during daily activities. We investigated the relationships between dyspnoea at the end of exercise and during daily activities with clinical measurements and mortality in COPD patients. We examined 143 male outpatients with moderate to very severe COPD. The peak Borg score at the end of progressive cycle ergometry was used for the assessment of peak dyspnoea rating during exercise, and the Baseline Dyspnea Index (BDI) score was used for dyspnoea with activities of daily living. Relationships between these dyspnoea ratings with other clinical measurements of pulmonary function, exercise indices, health status and psychological status were then investigated. In addition, their relationship with the 5-year mortality of COPD patients was also analyzed to examine their predictive ability. Although the BDI score was significantly correlated with airflow limitation, diffusing capacity, exercise indices, health status and psychological status, the Borg score at the end of exercise had non-existent or only weak correlations with them. The BDI score was strongly significantly correlated with mortality, whereas the Borg score was not. Dyspnoea during daily activities was more significantly correlated with objective and subjective measurements of COPD than dyspnoea at the end of exercise. In addition, the former was more predictive of mortality. Dyspnoea with activities of daily living is considered to be a better measurement for evaluating the disease severity of COPD than peak dyspnoea during exercise.
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Affiliation(s)
- Toru Oga
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 53, Kawahara, Shogoin, 606-8507, Japan.
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Miravitlles M. La calidad de vida en los pacientes con enfermedad pulmonar obstructiva crónica: criterios de cuantificación y repercusiones terapéuticas. Rev Clin Esp 2005; 205:439-42. [PMID: 16194479 DOI: 10.1157/13079073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronica diseases in developed countries. Prognosis of the disease is mainly determined by the degree of air flow obstruction. However, other factors, such as degree of deterioration of the quality of life related with health have been demonstrated to be significantly correlated with morbidity and mortality in COPD. Thus, one of the main objectives of the treatment of COPD is to improve the health condition of the patients, beyond the possible improvement of the lung function. New drugs developed for the treatment of COPD have shown a different impact on the health condition of those affected by COPD.
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Affiliation(s)
- M Miravitlles
- Servei de Pneumologia, Institut Clínic del Tòrax, IDIBAPS, Red Respira RTIC 03/11 ISCIII, Hospital Clínic, Barcelona.
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Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status. Am J Respir Crit Care Med 2003; 167:544-9. [PMID: 12446268 DOI: 10.1164/rccm.200206-583oc] [Citation(s) in RCA: 373] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this study, we analyzed the relationships of exercise capacity and health status to mortality in patients with chronic obstructive pulmonary disease (COPD). We recruited 150 male outpatients with stable COPD with a mean postbronchodilator FEV1 at 47.4% of predicted. Their pulmonary function, progressive cycle ergometry, and health status using the Chronic Respiratory Disease Questionnaire, the St. George's Respiratory Questionnaire (SGRQ), and the Breathing Problems Questionnaire were measured at entry. Among 144 patients who were available for the 5-year follow-up, 31 had died. Univariate Cox proportional hazards analysis revealed that the SGRQ total score and the Breathing Problems Questionnaire were significantly correlated with mortality; however, with the Chronic Respiratory Disease Questionnaire, the total score was not significantly correlated. Multivariate Cox proportional hazards analysis revealed that the peak oxygen uptake and the SGRQ total score were both predictive of mortality, independent of FEV1 and age. Stepwise Cox proportional hazards analysis revealed that the peak oxygen uptake was the most significant predictor of mortality. We found that exercise capacity and health status were significantly correlated with mortality, although different health status measures had different abilities to predict mortality. These results will have a potentially great impact on the multidimensional evaluation of disease severity in COPD.
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Affiliation(s)
- Toru Oga
- Respiratory Division, Kyoto-Katsura Hospital, Kyoto, Japan.
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