Influence of COPD exacerbations on health related quality of life

Background: An exacerbation is the most important adverse event in the progression of chronic obstructive pulmonary disease (COPD). Exacerbations appear to accelerate the decline in lung function that characterizes COPD, resulting in reduced physical activity, poorer quality of life and an increased risk of death. The aim of this study was to investigate the influence of chronic obstructive pulmonary disease exacerbations on health related quality of life (HRQL). Methods: 152 consecutive patients with COPD were enrolled into the study. We measured demographics and spirometry. HRQL was assessed by the Medical Outcomes Study Short Form (SF-36) and the St. George Respiratory Questionnaire (SGRQ). Results: The cohort consisted of 90 patients with 2 or less exacerbations per year, mean age 53±3.2 years and 62 patients with 3 or more exacerbations, mean age 55±3.8. In frequent exacerbators COPD was more severe: the mean FEV1% was 34.2±2.1% versus 52.3±2%, p <0.05. Grade of impairment of HRQL was higher in frequent than infrequent exacerbators: SGRQ (73.6±1.1 versus 57.1±1.6, p<0.01) and SF-36 (30.2±1.5 versus 41.1±1.2, p<0.01). Pearson correlation coefficient analysis demonstrates in COPD patients a significant positive correlation between the rate of exacerbations and the total scores of the SGRQ (r=0.61, p<0.01) and SF-36 (r=0.54, p<0.01). Conclusion: Compared with infrequent exacerbators, frequent exacerbators in our study were characterized at baseline by more severe COPD and more severe deterioration of the health related quality of life.