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| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 6
| Issue : 1 | Page : 17-22 |
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Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in Karachi Pakistan—A Cross-Sectional Study
Mubashir Zafar
Department of Public Health, College of Public Health, Imamm Abdul Rehman Bin Faisal university, Dammam, KSA
| Date of Submission | 18-Dec-2019 |
| Date of Decision | 14-Feb-2020 |
| Date of Acceptance | 20-Feb-2020 |
| Date of Web Publication | 30-Apr-2020 |
Correspondence Address:
Mubashir Zafar
Department of Public Health, College of Public Health, Imamm Abdul Rehman Bin Faisal university, Dammam, KSA
KSA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/mamcjms.mamcjms_92_19
Aims and Objective: A chronic obstructive pulmonary disease (COPD) is a major public health problem globally. The patients with COPD usually have dependence on society due to its nature. This study was designed to determine the health-related quality of life among COPD patients and its relationship with severity of disease. Methods: Total 54 patients were recruited through simple random sampling from the outpatient department of a tertiary care hospital. St Georges Respiratory Quality life validated structured questionnaire was used to determine the quality of life under cross sectional study design. Kruskal Wallis test, Pearson correlation and linear regression analysis were used to determine the relationship between health-related quality of life with severity of the disease. Results: The mean score of symptoms, activity, impact and total on health-related quality of life score is 60.34±12.39, 27.53±2.78, 44.98±5.08 and 23.83±2.69, respectively.. There was statistically significant positive correlation between forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1/FVC and health-related quality of life score. After adjustment of covariate in regression analysis, the variables that predicted SGRQ scores in COPD patients are age (P-value <0.04), smoking (P-value <0.01) and spirometry values (FEV1 and FVC.) (P-value <0.05). The health-related quality of life scores were significantly different among mild, moderate severe disease patients (P-value <0.05). Conclusion: Among COPD patients, the health-related quality of life was impaired, and it has decreased as severity of disease increased. Proper management of disease and improved awareness among patients regarding factors which affect the health-related quality of life among COPD patients is necessary.
Keywords: Chronic, life, obstructive, pulmonary, quality
How to cite this article:
Zafar M. Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in Karachi Pakistan—A Cross-Sectional Study. MAMC J Med Sci 2020;6:17-22 |
How to cite this URL:
Zafar M. Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in Karachi Pakistan—A Cross-Sectional Study. MAMC J Med Sci [serial online] 2020 [cited 2023 Jun 5];6:17-22. Available from: https://www.mamcjms.in/text.asp?2020/6/1/17/283521 |
| Introduction | |  |
Chronic obstructive pulmonary disease (COPD) is a common lung disease, and can be defined as chronic obstruction of lung airflow that interferes with normal breathing.[1] COPD is the fourth leading cause of death in the world.[2] It is estimated that 2.2 million deaths occurred every year due to COPD.[3] According to World Health Organization (WHO), the deaths from COPD will be increased by 30% every year and it will become third common cause of death worldwide by 2030.[4],[5] High amount of financing is required for management of COPD due to co-morbidity usually associated with the disease.[6]
COPD has affected the quality of life of patients leading to disability, which ultimately effects the patient’s families.[4] Patients often express frustration because they cannot perform their usual normal daily activities. The physical symptoms of disease restrict the daily activities of the patient. The common psychological symptoms such as anxiety, unemployment lead to dependency on the society, which leads to demographic burden in the society.[7]
Health-related quality of life (HQOL) was impaired among patients with COPD and is an important aspect for measuring the influence of chronic disease. There are different factors that contributed to the HQOL among COPD patients. The most important factor is mental functioning which means willing to participate in daily activities; activities of daily living (ADLs), social activities such as relationship with society.[8],[9],[10]
There are various symptoms of disease which may pose difficulty in performing daily activities. The most important problem experienced by COPD patients was dependency. They are dependent on the society because of severity of disease and they cannot perform daily activities such as bathing, eating.[11] There are several previous studies reporting that most important problem faced by COPD patients were fatigue after routine daily activities [12] and breathlessness which affect the HQOL.[13] Another aspect is the education and nutrition which were affected by breathlessness. A previous study results shows that COPD patients with high severity had low level of education and underweight (Low Body Mass index).[14] Psychological symptoms such as depression and anxiety were common among COPD patients.[15]
The prevalence of COPD in Pakistan is 2.1% in the population and around 6.9 million people were suffered from this disease.[16] A previous study found that COPD patients have no awareness regarding disease status and management of disease which lead to poor HQOL among COPD patients.[17] A study found that 27% of patients had co morbidities with COPD and only 10% patients had access to lung function test.[18] Approximately 33% of patients were hospitalized and 27% patients visited in emergency in year of 2018 due to severity of the disease. This means that treatment is available but unable to improve the HQOL among COPD patients.[19]
There is no previous conducted to determine the HQOL of COPD patients in Pakistan. This study helps to find out the important factors which contribute to HQOL among COPD patients and it also help the awareness of pulmonary specialist to focus on the patient HQOL with the management of disease. Result of this study will help to the chest physicians to determine the quality of life of COPD patients early because quality of life directly assocaited with mangement of patient. The objective of study is to determine the the HQOL among COPD patients in Pakistan.
Method
Study protocol was approved from hospital ethical committee. Confidentiality of study participation data was maintained. Informed written Consent was obtained before conducting the interview of the study participants.
The study was conducted in the Department of Chest Medicine at a tertiary care hospital in Karachi Pakistan. Hospital has 1000 bed and there are 70 departments. Data collection was started from the month of March 2019 to April 2019. It is a public sector tertiary care hospital and associated with Medical University. It is estimated that approximately 200 patients visited daily in department of chest medicine. It was cross sectional study. Independent variables are Age, sex, education, occupation, socio-economic status, residence, Cough, sputum, dyspnea, duration of illness, smoking status were taken as independent variables. Dpendent Variable is Health related quality of Life score (HQOL).
Sample size was calculated by WHO software calculator for health studies, 95% confidence interval, 0.05% significance level, and 5% margin of error, prevalence of quality of life among COPD patients from previous study was 5%.[20] The overall sample size is calculated is 54 patients.
Study participants were included in the study as diagnosed cases of COPD, age between 35 to 80 years, patients who gave consent. Exclusion Criteria for Patients exhibiting any other breathing illnesses (i.e. Asthma,), Patients exhibiting any psychiatric disorders. Patients exhibiting other co-morbidities like diabetes (DM), hypertension (HTN), cardiac abnormalities.
St. George’s Respiratory Questionnaire (SGRQ) was used to assess the HQOL in our participants. It is a disease-specific instrument which designed to measure impact on overall health, daily life and perceived well-being in patients with obstructive airway diseases. SGRQ was acceptable and easy to understand. Cronbach’s alpha reliability coefficient was 0.94 for the overall scale and 0.72 for “Symptoms”, 0.89 for “Activity”, and 0.89 for “Impacts” subscales.[20] English version was used. It consists of 50 items divided into three parts; part I − symptoms component and part II − impact component, part III activity component. A total score has been calculated as the sum of scores on the three parts. Scoring is done from a range of 0-100, with higher scores indicating better life. Each component score calculated separately by dividing the summed weights by the maximum possible weight for that component and expressing the result as a percentage: Score = 100 summed weights from all positive items in that component/sum of maximum possible weights for all items in that component. The total score was calculated with add up of all three components. Scores is converted into to weighted mean. Maximum score of each component as total Symptoms 566.2, Activity 982.9, Impacts 1652.8, Total (sum of maximum for all three components) 3201.9
The study participants were selected from outpatient department (OPD) through simple random sampling. First take a list of patients from the OPD, put up the list in the computer number generator software, software generates the list of patients randomly and then take a sample from the list. The questionnaire was distributed among participants Each participant was explained individually the contents of the questionnaire and the importance of this study regarding their health conditions. After obtaining the consent, questionnaire was filled from each participant and lung volumes were determined through spirometry. forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were recorded from spirometry. COPD stages classified according to GOLD criteria.[2]
Data were entered in EPI data software version 3.1.[36] Data file was imported to SPSS software version 23 for analysis, Frequency and proportion were calculated for descriptive statistics. SRGQ scores were used for quality of life. There are four categories of SRGQ scales, symptoms, activities, impact and total. Mean score for each category was calculated first then linear transformation of the scores was done to standardize the scores, scores ranged from 0 to 100. The formula applied for linear transformation is as follows:
[(Actual raw score−Lowest possible raw score)/Possible raw score range] *100.
To compare the stages of COPD, Kruskal Wallis test was used for non-normally distributed data, Tukey HSD post hoc test was used to detect the intergroup differences. Pearson correlation (r) was used to detect linear relationship between quantitative variables. Linear regression was used for determining the association between HRQOL scores and demographic and disease related variables. P < 0.05 considered significant.
| Results | | |
The mean (SD) age of study participants was 49.8± SD11.98 years. Majority of the study participants were male (54%), most (94.4%) of them living in urban area, 63% were smoker and 40.7% had positive family history of COPD. The mean and standard deviation of total, symptoms, activity and impact score of HQOL were 23.83±2.69, 60.34±12.39, 27.53±2.78 and 44.98±5.08 respectively [Table 1] and [Table 2]. | Table 1 Socio-demographic characteristics of study participants (n = 54)
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 | Table 2 Health-related quality of life score (HRQOL)a related to socio-demographic characteristics of study participants (n = 54)
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The significant difference of HQOL score was identified in age (P = 0.04), education level (P =0.04), ethnicity (P = 0.01) and smoker (P = 0.05) [Table 3]. | Table 3 Comparison between grades of COPD severity regarding SGRQ score (n = 54)
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The statistically significant difference of HQOL score between severity of COPD disease, as severity increased the quality of life score has decreased (P <0.05) [Table 4]. | Table 4 Correlation coefficient (r)a between SGRQ score and spirometry (n = 54)
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The correlation between HQOL score and spirometry values (FEV1, FVC and FEV1/FVC) were positively correlated and correlation coefficient value are (r= 0.26, 0.22 and 0.10) and statistically significant. (P < 0.05) [Table 5]. | Table 5 Adjusted association (multiple regression analysis) between total health-related quality of life score (HRQOL) and respiratory disease-related variable (n = 54)
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After adjustment of covariates, the predicator for HQOL score were age, education level, duration of COPD, stages of COPD, smoking and spirometry value (FEV1) were associated with quality of life score [Table 6].
| Discussion | | |
COPD is associated with number of other disorders such as mental disorder (depression), social impairment and physical disabilities. The result of this study found that patients with COPD has impaired health related quality of life. As the disease severity increased the HQOL score has decreased. The major predicator associated with HQOL were age, education level, duration of COPD and stages of COPD.
Among study participants, 14 patients had grade 4, 37 patients had grade III of COPD. Result of this study found that the total health related quality of life score was low in stage 3 and 4 of COPD patiens. This mean that severity of the disease increased and quality of life decreased. This results is consistents with the previous study results which showed that stage 4 patients of COPD were low HQOL score.[21],[22],[23],[24]
In this study the mean age of the study participants was 49.9 ±11.98 years. Result is found that as age increased the lung volumes were decreased. A previous study result found that as age is negatively correlated with the lung volume.[25] Lung function has commonly decreased as age increased due to environmental pollution and age-related changes appear in lung of human body.
In this study result found that male patients of COPD was low score compared to female COPD patiens, a previous study also found that male is more affected with COPD.[26] The common reason for this is that male is more exposure to environmental pollution. This result is consistent with other study which was conducted in Sweden.[27] Other studies also found that males had low health related quality of life score compared to the female.[28],[29],[30]
This study found that the higher education is associated with good health related quality of life, this result consistent with the other study which revealed that education is important predictor for quality of life.[31] The reason for this finding is that education gives awareness regarding health-seeking behavior.This study found that negative correlation between spirometry values (FEV1, FVC and FEV1/FVC) and quality of life scores. This result is consistent with the study, which was conducted in Norway, which found that high level of correlation between FVC and quality of life score. Its mean that as FVC decrease then quality of life also intercorrelated with total score and other component of score and each component is important role for quality of life.[32]
Result of this study found that smoking is directly associated with quality of life. Smokers of COPD patients had low quality of life score. In the previous study results found that smoking is the important predictor of HQOL.[33] Severity of disease also affected by smoking. Smokers of COPD patients were in stage 4 of COPD. Other studies results found that those COPD patients if quit smoking thier quality of life has been improved.[34],[35]
There are few limitations of this study. First, it’s a cross sectional study which fail to give causal inference due to lack of temporality. Second patients were included only from outpatient department of hospital which fails to represent COPD population. This is the first study to give the snap shot of health related quality of life among COPD patients. It is recommended that large scale study will be conduct to explore the in depth knowledge of this imprtant public health issue.
| Conclusion | | |
COPD patients had suffered poor health related quality of life with severity of disease decreased the health related quality of life. Age, education, gender is important predicator for health related quality of life in COPD patients. It is important that chest specialist should aware about the factors which affect the quality of life of COPD patients because they give counseling to COPD patients about how to improve the HQOL. Early detection of factors which contributed to quality of life will improved the management of COPD disease.
Acknowledgement
I should extend my sincere appreciation to hospital and students who participate in the data collection and provision of the necessary support that enabled me to fulfill this study.
Financial support and sponsorship
No funding source, project is self-funded.
Conflicts of Interest
There is no conflict of interest between authors.
Research involving human participants
Research involve human participants, research approved from ethical review committee from hospital, confidentiality of data has maintained Informed consent was obtained from each participant.
| References | | |
| 1. | Foda HD, Brehm A, Goldsteen K, Edelman NH. Inverse relationship between nonadherence to original GOLD treatment guidelines and exacerbations of COPD. International Journal of Chronic Obstructive Pulmonary Disease 2017;12:209.  |
| 2. | American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995;152:S77-S121. |
| 3. | Insel T, Cuthbert B, Garvey M., Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: the global burden of disease study. Lancet. 1997; 349: 1498–1504. US Department of Health and Human Services. National Strategy for Suicide Prevention: Goals and Objectives for Action. Rockville. Yale Textbook of Public Psychiatry. 2016;15;349:111. |
| 4. | |
| 5. | Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, Nair H, Gasevic D, Sridhar D, Campbell H, Chan KY. Global and regional estimates of COPD prevalence: systematic review and meta-analysis. Journal of Global Health 2015;5:5-9. |
| 6. | Lamprecht B, Soriano JB, Studnicka M, Kaiser B, Vanfleteren LE, Gnatiuc L, Burney P, Miravitlles M, García-Rio F, Akbari K, Ancochea J. Determinants of underdiagnosis of COPD in national and international surveys. Chest 2015;148:971-85. |
| 7. | Wheaton AG, Ford ES, Cunningham TJ, Croft JB. Chronic obstructive pulmonary disease, hospital visits, and comorbidities: National Survey of Residential Care Facilities, 2010. Journal of Aging and Health 2015;27:480-99. |
| 8. | Sigurgeirsdottir J, Halldorsdottir S, Arnardottir RH, Gudmundsson G, Bjornsson EH. COPD patients’ experiences, self-reported needs, and needs-driven strategies to cope with self-management. International Journal of Chronic Obstructive Pulmonary Disease 2019;14:1033. |
| 9. | Castelino F, Prabhu M, Pai MS, Kamath A. Lived experiences of patients with chronic obstructive pulmonary diseases (COPD)—qualitative review. Indian Journal of Public Health 2018;9:263. |
| 10. | Stridsman C, Zingmark K, Lindberg A, Skär L. Creating a balance between breathing and viability: experiences of well-being when living with chronic obstructive pulmonary disease. Primary Health Care Research & Development 2015;16:42-52. |
| 11. | Lindenmeyer A, Greenfield SM, Greenfield C, Jolly K. How do people with COPD value different activities? An adapted meta-ethnography of qualitative research. Qualitative Health Research 2017;27:37-50. |
| 12. | Dua R, Das A, Kumar A, Kumar S, Mishra M, Sharma K. Association of comorbid anxiety and depression with chronic obstructive pulmonary disease. Lung India: Official Organ of Indian Chest Society 2018;35:31. |
| 13. | Vaske I, Kenn K, Keil DC, Rief W, Stenzel NM. Illness perceptions and coping with disease in chronic obstructive pulmonary disease: effects on health-related quality of life. Journal of Health Psychology 2017;22:1570-81. |
| 14. | Brooks D. Supervised walking training improves health-related quality of life and exercise endurance in people with chronic obstructive pulmonary disease [commentary]. Journal of Physiotherapy 2016;62:50. |
| 15. | Negi H, Sarkar M, Raval AD, Pandey K, Das P. Health-related quality of life in patients with chronic obstructive pulmonary disease in north India. J Postgrad Med 2014;60:7-11. [ PUBMED] [Full text] |
| 16. | |
| 17. | Brown DW, Pleasants R, Ohar JA, Kraft M, Donohue JF, Mannino DM et al. Health-related quality of life and chronic obstructive pulmonary disease in North Carolina. N Am J Med Sci 2010;2:60-5. |
| 18. | Sundh J, Johansson G, Larsson K, Linden A, Löfdahl CG, Janson C, Sandström T. Comorbidity and health-related quality of life in patients with severe chronic obstructive pulmonary disease attending Swedish secondary care units. International Journal of Chronic Obstructive Pulmonary Disease 2015;10:173. |
| 19. | Brandl M, Böhmer MM, Brandstetter S, Finger T, Fischer W, Pfeifer M, Apfelbacher C. Factors associated with generic health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study. Journal of Thoracic Disease 2018;10:766. |
| 20. | Asakura T, Funatsu Y, Ishii M, Namkoong H, Yagi K, Suzuki S, Asami T, Kamo T, Fujiwara H, Uwamino Y, Nishimura T. Health-related quality of life is inversely correlated with C-reactive protein and age in mycobacterium avium complex lung disease: a cross-sectional analysis of 235 patients. Respiratory Research 2015;16:145. |
| 21. | Negi H, Sarkar M, Raval AD, Pandey K, Das P. Health-related quality of life in patients with chronic obstructive pulmonary disease in north India. J Postgrad Med 2014;60:7-11. [ PUBMED] [Full text] |
| 22. | Guo JB, Chen BL, Lu YM, Zhang WY, Zhu ZJ, Yang YJ, Zhu Y. Tai Chi for improving cardiopulmonary function and quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clinical Rehabilitation 2016;30:750-64. |
| 23. | Brown DW, Pleasants R, Ohar JA, Kraft M, Donohue JF, Mannino DM et al. Health-related quality of life and chronic obstructive pulmonary disease in North Carolina. N Am J Med Sci 2010;2:60-5. |
| 24. | Obaseki DO, Erhabor GE, Awopeju OF, Obaseki JE, Adewole OO. Determinants of health-related quality of life in a sample of patients with chronic obstructive pulmonary disease in Nigeria using the St. George’s respiratory questionnaire. Afr Health Sci 2013;13:694-702. |
| 25. | Agustí A, Celli B. Natural history of COPD: gaps and opportunities. ERJ Open Research 2017;3:00117-2017. |
| 26. | Thomsen SF. Epidemiology and natural history of atopic diseases. European Clinical Respiratory Journal 2015;2:24642. |
| 27. | Gruenberger JB, Vietri J, Keininger DL, Mahler DA. Greater dyspnea is associated with lower health-related quality of life among European patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease 2017;12:937. |
| 28. | Obaseki DO, Erhabor GE, Awopeju OF, Obaseki JE, Adewole OO. Determinants of health-related quality of life in a sample of patients with chronic obstructive pulmonary disease in Nigeria using the St. George’s respiratory questionnaire. Afr Health Sci 2013;13:694-702. |
| 29. | Jankowska-Polańska B, Kasprzyk M, Chudiak A, Uchmanowicz I. Effect of disease acceptance on quality of life in patients with chronic obstructive pulmonary disease (COPD). Advances in Respiratory Medicine 2016;84:3-10. |
| 30. | Uppal M, Gupta B, Suri JC, Mittal V. Factors affecting severity, functional parameters, and quality of life in COPD patients. J Indian Acad Clin Med 2014;15:42-6. |
| 31. | Stridsman C, Zingmark K, Lindberg A, Skär L. Creating a balance between breathing and viability: experiences of well-being when living with chronic obstructive pulmonary disease. Primary Health Care Research & Development 2015;16:42-52. |
| 32. | Pascal OI, Trofor AC, Lotrean LM, Filipeanu D, Trofor L. Depression, anxiety and panic disorders in chronic obstructive pulmonary disease patients: correlations with tobacco use, disease severity and quality of life. Tobacco Induced Diseases 2017;15:23. |
| 33. | Carone M, Antoniu S, Baiardi P, Digilio VS, Jones PW, Bertolotti G. QuESS Group. Predictors of mortality in patients with COPD and chronic respiratory failure: the quality-of-life evaluation and survival study (QuESS): a three-year study. COPD: J of Chronic Obst Pulm Dis 2016;13:130-8. |
| 34. | George P, Constantine V. Smoking cessation can improve quality of life among COPD patients: validation of the clinical COPD questionnaire into Greek. BMC Pulm Med 2011;2:11-13. |
| 35. | Labonté LE, Tan WC, Li PZ, Mancino P, Aaron SD, Benedetti A, Chapman KR, Cowie R, FitzGerald JM, Hernandez P, Maltais F. Undiagnosed chronic obstructive pulmonary disease contributes to the burden of health care use. Data from the Can COLD study. American J of Res and Crit Care Med 2016;194:285-98. |
| 36. | |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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