Factors influencing decline in quality of life in smokers without airflow obstruction: The COPDGene study.

Publication Title

Respiratory medicine

Authors

Trisha M Parekh
Smita Bhatia
Andrea Cherrington
Young-Il Kim
Allison A. Lambert, Division of Pulmonary and Critical Care Medicine, Department of Medicine and Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MarylandFollow
Anand Iyer
Elizabeth A Regan
Dawn L DeMeo
MeiLan Han
Mark T Dransfield

Document Type

Article

Publication Date

1-1-2020

Keywords

Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Quality of Life; Smokers; Spirometry

Abstract

INTRODUCTION: Current and former smokers with normal spirometry and with Preserved Ratio Impaired Spirometry (PRISm) experience respiratory events similar to chronic obstructive pulmonary disease (COPD) exacerbations. Exacerbations significantly reduce quality of life (QoL) in COPD patients however the effect of respiratory exacerbations on QoL in these groups is unknown. We hypothesized that exacerbations and change in exacerbation status would predict QoL decline among normal spirometry and PRISm participants in COPDGene.

METHODS: COPDGene is a multicenter, longitudinal study in the U.S. designed to identify genetic determinants of COPD. We enrolled study subjects in Phase 1 of COPDGene and performed multivariable logistic regression models to determine independent predictors of decline in quality of life [>4 points on the St George's Respiratory Questionnaire (SGRQ)]. Separate analyses were performed for current and former smokers with normal spirometry and PRISm. Frequent exacerbator status was defined by > 2 moderate or >1 severe exacerbations in the year prior to the baseline and year 5 follow-up visits.

RESULTS: Independent predictors of QoL deterioration included current smoking, higher exacerbation frequency, and a change from infrequent to frequent exacerbation status (REF: infrequent to infrequent exacerbation status) in both groups [PRISm (OR = 3.15,95%CI, 1.67-5.94), normal spirometry (OR = 4.72,95%CI, 3.25-6.86)]. A change from frequent to infrequent exacerbation status did not lower the odds of QoL decline in either cohort.

CONCLUSION: Continued smoking and the onset of frequent exacerbations were predictors of QoL decline in smokers with normal spirometry and PRISm. Further studies are needed to identify modifiable factors associated with decline in QoL in smokers.

Specialty/Research Institute

Pulmonary Medicine