Respiratory Symptom Frequency Has Significant Impact on Patients’ HRQoL

Key Point

Incidence and persistence of chronic cough, dyspnea, and dyspnea grade 2 have a great negative impact on the mental and physical components of patient health-related quality of life.

Prior research has indicated that patients with asthma and COPD have lower health-related quality of life (HRQoL). However, which symptoms of these multifaceted diseases have the most impact on a patient’s well being is less understood. A team of researchers from Haukeland University Hospital in Bergen, Norway, set out to examine how the incidence and persistence of respiratory symptoms negatively impact HRQoL. The results of their research, known as the Hordaland County Cohort Study, were reported in the June Chest.

“To our knowledge, this is the first study to examine the relationship between changes in respiratory symptoms and HRQoL in a general population,” stated Marianne Voll-Aanerud, MD, a research fellow and junior physician in the Department of Thoracic Medicine, and coauthors. All 3,786 potential study participants lived in Bergen and surrounding municipalities. They were asked to complete questionnaires about incidence, remission, and persistence of six respiratory symptoms (morning cough, chronic cough, phlegm cough, wheeze, dyspnea attacks, and dyspnea grade 2) and to submit to a clinical examination that included completion of the Short Form 12 (SF-12) to measure HRQoL. Complete data existed for 2,306 participants.

Women were more likely than men to report never having cough symptoms and to be never smokers, while men were significantly more likely to never have had symptoms of dyspnea although they had more pack-years of smoking. Patterns of SF-12 score were similar across all six symptoms: Participants who had never experienced a particular symptom had the highest scores on both the physical and mental components, participants with remission had the second-highest component scores, and those who reported incidence or persistence of a symptom had the second-lowest and lowest scores, respectively. Chronic cough, dyspnea attacks, and dyspnea grade 2 were associated with the largest negative influences on both components of the SF-12.

“In general, the physical component score was more reduced than the mental component score in symptomatic subjects,” reported the authors. For example, mean mental SF-12 score was 46.6 in patients with persistent chronic cough, as well as in those with persistent dyspnea grade 2, while mean physical scores were 41.1 and 36.2, respectively. However, they noted that this trend was reduced after adjustment for gender, age, educational level, and smoking status, as age was found to have significant interactions with wheeze, dyspnea grade 2, and dyspnea attacks, while smoking significantly interacted with wheeze and phlegm cough.

The authors posited that chronic cough, dyspnea attacks, and dyspnea grade 2 have a larger impact on activities of daily living or could be indicators of more serious disease than the other symptoms, as these factors proved to be the most potent predictors of reduced physical and mental component scores. Also, they noted that some, but not all, symptoms experienced by patients are the result of chronic disease. “Regardless, quality of life is affected by respiratory symptoms that underscore the need to diagnose and treat symptoms properly,” they asserted.           

—Jessica Dziedzic

Reference
Voll-Aanerud M, Eagan TM, Wentzel-Larsen T, et al. Changes in respiratory symptoms and health-related quality of life. Chest. 2007;131(6):1890-1897.

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