Health status deterioration in subjects with mild to moderate airflow obstruction, a six years observational study

Fernanda Machado Rodrigues, Heleen Demeyer, Matthias Loeckx, Miek Hornikx, Hans Van Remoortel, Wim Janssens, Thierry Troosters, Fernanda Machado Rodrigues, Heleen Demeyer, Matthias Loeckx, Miek Hornikx, Hans Van Remoortel, Wim Janssens, Thierry Troosters

Abstract

Background: Patients with COPD need to cope with a disabling disease, which leads to health status impairment.

Aim: To investigate the long term change of health status in subjects with mild to moderate airflow obstruction and to compare this to subjects without airflow obstruction, with and without a smoking history. Second, to investigate the factors potentially associated to rapid health status decline in our total cohort.

Methods: Two hundred and one subjects were included. Generic [Short form 36 health survey (SF36) and EuroQol - 5 dimensions (EQ-5D)] and disease specific [Clinical COPD questionnaire (CCQ) and COPD Assessment Test (CAT)] health status questionnaires were regularly repeated over a six years period. Other functional outcomes comprised measures of lung function, physical fitness, physical activity and emotional state.

Results: On average, health status decline did not differ between groups with the exception of the EQ-5D index, which deteriorated faster in subjects with airflow obstruction compared to the never smoking control group [- 0.018(0.008) versus 0.00006(0.003), p = 0.03]. Subjects presenting at least one exacerbation had faster rate of deterioration measured with CAT [0.91(0.21) versus - 0.26(0.25), p < 0.01]. Characteristics of the fast declining group were older age, worse lung function, physical fitness, physical activity and disease specific baseline health status. Subjects with airflow obstruction had a 2.5 (95% CI 1.36-4.71) higher risk of presenting fast overall health status decline. Fast overall decline was associated with the presence of acute exacerbation(s) (44% of the subjects with exacerbation(s) versus 17% of subjects without exacerbation, p = 0.03). Changes in fat free mass, functional exercise capacity and in symptoms of anxiety and depression correlated weakly to changes in health status measured with all questionnaires.

Conclusion: Subjects with mild airflow obstruction present a significant deterioration of health status, which is generally not much faster compared to smoking and never smoking controls. Subjects with fast decline in overall health status are older and more likely to have airflow obstruction, acute respiratory exacerbation(s), reduced physical fitness, physical activity and impaired COPD specific health status at baseline.

Trial registration: NCT01314807 - retrospectively registered on March 2011.

Keywords: Aging; Airflow obstruction; Chronic obstructive pulmonary disease; Health status; Longitudinal studies.

Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
CONSORT type flow chart of inclusions and follow up. Drop outs are indicated immediately after the last attended visit. In case of decease, this is also indicated after the last attended visit by the subject, even if the decease occurred at a later stage. The number of deceases between two visits are included in the number of drop outs and are specified within brackets
Fig. 2
Fig. 2
Visual representation of the changes in health status obtained with the mixed model. Data as average and standard error. Panel a) Short form 36 health survey physical component summary (SF36 PCS); b) Short form 36 health survey mental component summary (SF36 MCS); c) Generic EuroQol 5 dimensions utility index (EQ-5D index); d) Generic EuroQol 5 dimensions visual analog scale (EQ-5D VAS); e) Clinical COPD Questionnaire (CCQ); f) COPD assessment test (CAT). The airflow obstruction group (AO) is represented by circles and solid black line, the smoking control group (SC) by squares and solid dark grey line and the never smoking control group (NSC) by triangles and dashed light grey line. AO n=, SC n= and NSC n = refer to the number of valid of measurements in the three groups, in each time-point, for each instrument

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