Chest
Volume 142, Issue 3, September 2012, Pages 704-711
Journal home page for Chest

Original Research
Health-Related Quality of Life
Relationship Between Lung Function Impairment and Health-Related Quality of Life in COPD and Interstitial Lung Disease

https://doi.org/10.1378/chest.11-1332Get rights and content

Background

Health-related quality-of-life (HRQL) measures have been correlated with lung function in patients with COPD and interstitial lung disease (ILD). However, different pathophysiologic mechanisms may influence how these distinct diseases affect HRQL, resulting in differing HRQL by pulmonary diagnosis among patients with similar severity of ventilatory impairment.

Methods

The National Heart, Lung, and Blood Institute Lung Tissue Research Consortium provided data on well-characterized participants with COPD (n = 576) and ILD (n = 405) at four clinical sites. Using multiple linear regression, we examined the effects of FEV1 (% predicted) and diagnosis (ILD vs COPD) on HRQL scores, including total St. George Respiratory Questionnaire (SGRQ) scores and Short Form-12 (SF-12) physical component summary (PCS) and mental component summary (MCS) scores.

Results

Participants with ILD had, on average, higher SGRQ scores (15.33 points; 95% CI, 12.46-18.19; P <.001) and lower SF-12 PCS scores (− 4.73 points; 95% CI, − 6.31 to − 3.14; P <.001) compared with patients with COPD with similar FEV1 % predicted values, indicating worse HRQL. The specific diagnosis also modified the effect of FEV1 on the total SGRQ score (P = .003) and the SF-12 PCS score (P = .03). There was no relationship between lung function and SF-12 MCS scores.

Conclusions

HRQL scores were worse for patients with ILD compared with patients with COPD with similar degrees of ventilatory impairment. Differences in dyspnea mechanism or in the rate of disease progression may account for these differences in HRQL.

Section snippets

Study Design

Since September 2005, the LTRC has been enrolling patients with COPD or ILD from four clinical centers: Mayo Clinic (Rochester, Minnesota), University of Colorado, University of Michigan, and University of Pittsburgh. Inclusion criteria are age ≥ 21 years and (1) clinical indication of ILD leading to surgical lung biopsy, (2) diagnosis of COPD leading to treatment with lung volume reduction surgery, (3) diagnosis of ILD or COPD in patients listed for lung transplantation, or (4) lung nodule or

Patient Characteristics

Compared with patients with COPD, patients with ILD were younger and had greater diversity with respect to race and ethnicity (Table 1). However, the majority of patients in both groups were Caucasian. A higher proportion of patients with ILD had diabetes, and more patients with COPD had a history of cancer.

Among patients with ILD, the most common diagnosis was idiopathic pulmonary fibrosis (IPF) (n = 239, 59.0%), followed by hypersensitivity pneumonitis (n = 45, 11.1%) and nonspecific

Discussion

The main finding of this study is that patients with ILD have worse HRQL scores compared with those with COPD with similar severity of ventilatory impairment as assessed by FEV1. This was true for both a respiratory disease-specific measure of HRQL (SGRQ) and a generic measure of HRQL (SF-12 PCS). The mechanism causing this difference is unclear but may be related to differences in disease pathophysiology. Patients with ILD experience a concomitant decline in FEV1 and FVC as a result of

Acknowledgments

Author contributions: Dr Berry is the guarantor of this manuscript and is responsible for this work as a whole, from inception to publication.

Dr Berry: contributed to conception, hypotheses delineation, study design, data analysis, results interpretation, and writing and revision of the manuscript.

Dr Drummond: contributed to conception, hypotheses delineation, study design, data analysis, results interpretation, and writing and revision of the manuscript.

Dr Han: contributed to the conception,

References (35)

  • O Nishiyama et al.

    Health-related quality of life in patients with idiopathic pulmonary fibrosis. What is the main contributing factor?

    Respir Med

    (2005)
  • DA Mahler et al.

    Evaluation of the short-form 36-item questionnaire to measure health-related quality of life in patients with COPD

    Chest

    (1995)
  • PW Jones et al.

    A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire

    Am Rev Respir Dis

    (1992)
  • M Weatherall et al.

    Quality of life measured by the St George's Respiratory Questionnaire and spirometry

    Eur Respir J

    (2009)
  • E Ståhl et al.

    Health-related quality of life is related to COPD disease severity

    Health Qual Life Outcomes

    (2005)
  • ED Pereira et al.

    Influence of respiratory function parameters on the quality of life of patients with COPD

    J Bras Pneumol

    (2009)
  • ML Moy et al.

    Multivariate models of determinants of health-related quality of life in severe chronic obstructive pulmonary disease

    J Rehabil Res Dev

    (2009)
  • Cited by (29)

    • Functional impact of sarcopenia in respiratory muscles

      2016, Respiratory Physiology and Neurobiology
      Citation Excerpt :

      Respiratory diseases associated with old age, such as pneumonia (3-fold higher incidence in those >65 years of age) (Chong and Street, 2008; Janssens and Krause, 2004), already account for ∼7% of direct healthcare expenditures in the USA amounting to nearly $100 billion (National Institutes of Health: Fact Book Fiscal Year, 2012). Not only do these respiratory diseases diminish the quality of life in old age (Berry et al., 2012), they are also a leading cause of death in the elderly population (Heron, 2011; Xu et al., 2010). Indeed, the elderly are at greater risk for hospitalization and many are admitted to intensive care units because of respiratory failure frequently requiring prolonged mechanical ventilation (Creditor, 1993; de Jonghe et al., 2002, 2009; Hamel et al., 2005; Ray et al., 2006; Turrentine et al., 2006).

    • Correlation of regional emphysema and lung cancer: A lung tissue research consortium-based study

      2014, Journal of Thoracic Oncology
      Citation Excerpt :

      Participants for this study were identified in the NHLBI LTRC database.11

    View all citing articles on Scopus

    Funding/Support: This study was supported by the National Institutes of Health [Grant 1KL2RR025006-01] and the National Heart, Lung, and Blood Institute [Grant NO1-HR-46164].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    View full text