Symptom distress and quality of life in patients with advanced chronic obstructive pulmonary disease.

Although chronic obstructive pulmonary disease (COPD) is a highly prevalent and disabling illness, few empirical studies have evaluated the impact of the disease on symptom distress, functional status, and quality of life. These outcomes were explored in a prospective survey of 100 patients with advanced COPD. Patients were recruited from two academic centers. The mean forced expiratory volume in 1 second (FEV1) was 24.4% (standard deviation=3.9). Validated instruments were used to assess symptom distress (Memorial Symptom Assessment Scale [MSAS]), mental health (Mental Health Inventory [MHI]-5), functional status (Sickness Impact Profile [SIP]), quality of life (Multidimensional Index of Life Quality [MILQ]), spirituality (Functional Assessment of Chronic Illness Therapy [FACIT] Spirituality Scale), and comorbid conditions (Charlson Comorbidity Index). The most prevalent symptoms were dyspnea (94%), fatigue (71%), xerostomia (60%), coughing (56%), and anxiety (51%). Other symptoms with high prevalence were drowsiness (47%), irritability (42%), feeling nervous (40%), and wheezing (40%). Significant pain was reported in about one-third of patients. Patients reported relatively high levels of overall functional impairment (SIP median=24.0) and modest impairment in overall quality of life (MILQ median=52). Overall, psychological well-being was relatively unimpaired (median=24.5), and the comfort derived from faith was intact (FACIT median=2.5). Impairment in quality of life was strongly associated with symptom distress (MSAS-GDI; r=-0.74, P<0.001), functional impairment (SIP total; r=-0.59, P<0.001), female sex (r=-0.26, P=0.01), and poor psychological well-being (MHI-5; r=0.68, P<0.001). In multivariate analyses, poor quality of life was strongly correlated with higher total symptom distress, sickness-related dysfunction, and lower levels of psychological well-being (R(2)=0.66). In addition, two specific psychological symptoms-worrying and feeling irritable-were independently predictive of poor quality of life. Patients with advanced COPD have multiple distressing symptoms and a high prevalence of disturbances in mood, functional status, and quality of life. A focus on ameliorating prevalent physical symptoms and psychological distress may lead to an improvement in the overall quality of life in this patient population.

[1]  H. Scher,et al.  The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. , 1994, European journal of cancer.

[2]  W. Gallo,et al.  The association of symptoms with health outcomes in chronically ill adults. , 2007, Journal of pain and symptom management.

[3]  D. Heyland,et al.  Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the memorial symptom assessment scale. , 2003, Journal of pain and symptom management.

[4]  C. Ritchie,et al.  Do Palliative Consultations Improve Patient Outcomes? , 2008, Journal of the American Geriatrics Society.

[5]  H. Thaler,et al.  Memorial Symptom Assessment Scale , 2004, Expert review of pharmacoeconomics & outcomes research.

[6]  R. Hambleton,et al.  Development of the multidimensional index of life quality. A quality of life measure for cardiovascular disease. , 1996, Medical care.

[7]  P. Diehr,et al.  Functional status and patient satisfaction a comparison of ischemic heart disease, obstructive lung disease, and diabetes mellitus , 2005, Journal of General Internal Medicine.

[8]  P. Porterfield,et al.  Changes in quality of life following admission to palliative care units , 2001, Palliative medicine.

[9]  Amir Sharafkhaneh,et al.  Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. , 2006, Psychosomatics.

[10]  J. Ware,et al.  The structure of psychological distress and well-being in general populations. , 1983, Journal of consulting and clinical psychology.

[11]  M. Rabow,et al.  Ethnic differences in pain among outpatients with terminal and end-stage chronic illness. , 2005, Pain medicine.

[12]  M. Groenvold,et al.  A longitudinal study of palliative care , 2005, Cancer.

[13]  G. Ungvari,et al.  Prevalence and correlates of depression in Chinese elderly patients with pneumoconiosis , 2006, Aging & mental health.

[14]  M. Tinetti,et al.  Range and severity of symptoms over time among older adults with chronic obstructive pulmonary disease and heart failure. , 2007, Archives of internal medicine.

[15]  M. Tinetti,et al.  The burden of symptoms among community-dwelling older persons with advanced chronic disease. , 2004, Archives of internal medicine.

[16]  M. Feuerman,et al.  Symptom and quality of life survey of medical oncology patients at a Veterans Affairs medical center , 2000, Cancer.

[17]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[18]  S. Tennstedt,et al.  Symptom distress and quality of life in patients with advanced congestive heart failure. , 2008, Journal of pain and symptom management.

[19]  M. Bergner,et al.  The Sickness Impact Profile: Development and Final Revision of a Health Status Measure , 1981, Medical care.

[20]  E. Pfeiffer.  A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients † , 1975, Journal of the American Geriatrics Society.

[21]  H. Thaler,et al.  Symptom prevalence, characteristics and distress in a cancer population , 1994, Quality of Life Research.

[22]  M. Decramer,et al.  Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey , 2002, European Respiratory Journal.