Role of clinical questionnaires in optimizing everyday care of chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of disability in all its stages, and death in patients with moderate or severe obstruction. At present, COPD is suboptimally managed; current health is often not measured properly and hardly taken into account in management plans, and the future risk for patients with regard to health status and quality of life is not being evaluated. This review addresses the effect of COPD on the lives of patients and examines ways in which existing assessment tools meet physicians' needs for a standardized, simple method to measure consistently the full impact of COPD on patients in routine clinical practice. Current assessment of COPD severity tends to focus on airflow limitation, but this does not capture the full impact of the disease and is not well correlated with patient perception of symptoms and health-related quality of life. Qualitative studies have demonstrated that patients usually consider COPD impact in terms of frequency and severity of symptoms, and physical and emotional wellbeing. However, patients often have difficulty expressing their disease burden and physicians generally have insufficient time to collect this information. Therefore, it is important that methods are implemented to help generate a more complete understanding of the impact of COPD. This can be achieved most efficiently using a quick, reliable, and standardized measure of disease impact, such as a short questionnaire that can be applied in daily clinical practice. Questionnaires are precision instruments that contribute sensitive and specific information, and can potentially help physicians provide optimal care for patients with COPD. Two short, easy-to-use, specific measures, ie, the COPD Assessment Test and the Clinical COPD Questionnaire, enable physicians to assess patients' health status accurately and improve disease management. Such questionnaires provide important measurements that can assist primary care physicians to capture the impact of COPD on patients' daily lives and wellbeing, and improve long-term COPD management.

Keywords: COPD assessment test; chronic obstructive pulmonary disease; disease management; health status; quality of life; questionnaire.

Figures

Figure 1

Symptom frequency in individuals with COPD (evaluation of worst three-month period in past year). Patients participating in the Confronting COPD in America survey were asked about the frequency of their symptoms during their worst three-month period in the past year (ie, “Has there been any three-month period in the past year when you experienced … [read item] – every day, most days a week, a few days a week, a few days a month, less than that?”). A high proportion of patients reported that they frequently experienced specific disease-associated outcomes during their worst period in the past year. Reproduced with permission from GlaxoSmithKline.

Figure 2

Relationship between health status as measured by the SGRQ, and FEV1 and GOLD stage. Patients’ perception of symptoms and health-related quality of life, as assessed by the SGRQ, were not well correlated with objective pulmonary function measurements, such as FEV1 and GOLD stage. Adapted from Jones PW. Health status measurement in chronic obstructive pulmonary disease. Thorax. 2001;56:880–887 with permission from the BMJ Publishing Group Limited. Abbreviations: SGRQ, St George’s Respiratory Questionnaire; FEV1, forced expiratory volume in one second; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Figure 3

The clinical COPD questionnaire. Reproduced with permission from Thys van der Molen.

Figure 4

The COPD assessment test. Reproduced with permission from GlaxoSmithKline.