Gender associated differences in determinants of quality of life in patients with COPD: a case series study

Health and Quality of Life Outcomes, Sep 2006

Background The influence of gender on the expression of COPD has received limited attention. Quality of Life (QoL) has become an important outcome in COPD patients. The aim of our study was to explore factors contributing to gender differences in Quality of Life of COPD patients. Methods In 146 men and women with COPD from a pulmonary clinic we measured: Saint George's Respiratory Questionnaire (SGRQ), age, smoking history, PaO2, PaCO2, FEV1, FVC, IC/TLC, FRC, body mass index (BMI), 6 minute walk distance (6MWD), dyspnea (modified MRC), degree of comorbidity (Charlson index) and exacerbations in the previous year. We explored differences between genders using Mann-Whitney U-rank test. To investigate the main determinants of QoL, a multiple lineal regression analysis was performed using backward Wald's criteria, with those variables that significantly correlated with SGRQ total scores. Results Compared with men, women had worse scores in all domains of the SGRQ (total 38 vs 26, p = 0.01, symptoms 48 vs 39, p = 0.03, activity 53 vs 37, p = 0.02, impact 28 vs 15, p = 0.01). SGRQ total scores correlated in men with: FEV1% (-0.378, p < 0.001), IC/TLC (-0.368, p = 0.002), PaO2 (-0.379, p = 0.001), PaCO2 (0.256, p = 0.05), 6MWD (-0.327, p = 0.005), exacerbations (0.366, p = 0.001), Charlson index (0.380, p = 0.001) and MMRC (0.654, p < 0.001). In women, the scores correlated only with FEV1% (-0.293, p = 0.013) PaO2 (-0.315, p = 0.007), exacerbations (0.290, p = 0.013) and MMRC (0.628, p < 0.001). Regression analysis (B, 95% CI) showed that exercise capacity (0.05, 0.02 to 0.09), dyspnea (17.6, 13.4 to 21.8), IC/TLC (-51.1, -98.9 to -3.2) and comorbidity (1.7, 0.84 to 2.53) for men and dyspnea (9.7, 7.3 to 12.4) and oxygenation (-0.3, -0.6 to -0.01) for women manifested the highest independent associations with SGRQ scores. Conclusion In moderate to severe COPD patients attending a pulmonary clinic, there are gender differences in health status scores. In turn, the clinical and physiological variables independently associated with those scores differed in men and women. Attention should be paid to the determinants of QoL scores in women with COPD.

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Gender associated differences in determinants of quality of life in patients with COPD: a case series study

Health and Quality of Life Outcomes Gender associated differences in determinants of quality of life in patients with COPD: a case series study Juan P de Torres 1 Ciro Casanova 1 Concepcin Hernndez 1 Juan Abreu 1 Angela Montejo de Garcini 1 Armando Aguirre-Jaime 1 Bartolome R Celli 0 0 Pulmonary and Critical Care Division, St. Elizabeth's Medical Center , Boston , USA 1 Respiratory Research Unit, Hospital Nuestra Sra de Candelaria , Tenerife , Spain Background: The influence of gender on the expression of COPD has received limited attention. Quality of Life (QoL) has become an important outcome in COPD patients. The aim of our study was to explore factors contributing to gender differences in Quality of Life of COPD patients. Methods: In 146 men and women with COPD from a pulmonary clinic we measured: Saint George's Respiratory Questionnaire (SGRQ), age, smoking history, PaO2, PaCO2, FEV1, FVC, IC/ TLC, FRC, body mass index (BMI), 6 minute walk distance (6MWD), dyspnea (modified MRC), degree of comorbidity (Charlson index) and exacerbations in the previous year. We explored differences between genders using Mann-Whitney U-rank test. To investigate the main determinants of QoL, a multiple lineal regression analysis was performed using backward Wald's criteria, with those variables that significantly correlated with SGRQ total scores. Results: Compared with men, women had worse scores in all domains of the SGRQ (total 38 vs 26, p = 0.01, symptoms 48 vs 39, p = 0.03, activity 53 vs 37, p = 0.02, impact 28 vs 15, p = 0.01). SGRQ total scores correlated in men with: FEV1% (-0.378, p < 0.001), IC/TLC (-0.368, p = 0.002), PaO2 (-0.379, p = 0.001), PaCO2 (0.256, p = 0.05), 6MWD (-0.327, p = 0.005), exacerbations (0.366, p = 0.001), Charlson index (0.380, p = 0.001) and MMRC (0.654, p < 0.001). In women, the scores correlated only with FEV1% (-0.293, p = 0.013) PaO2 (-0.315, p = 0.007), exacerbations (0.290, p = 0.013) and MMRC (0.628, p < 0.001). Regression analysis (B, 95% CI) showed that exercise capacity (0.05, 0.02 to 0.09), dyspnea (17.6, 13.4 to 21.8), IC/TLC (-51.1, -98.9 to -3.2) and comorbidity (1.7, 0.84 to 2.53) for men and dyspnea (9.7, 7.3 to 12.4) and oxygenation (-0.3, -0.6 to -0.01) for women manifested the highest independent associations with SGRQ scores. Conclusion: In moderate to severe COPD patients attending a pulmonary clinic, there are gender differences in health status scores. In turn, the clinical and physiological variables independently associated with those scores differed in men and women. Attention should be paid to the determinants of QoL scores in women with COPD. - Background Chronic Obstructive Pulmonary Disease (COPD) primarily affects the airway and lung parenchyma while it also induces clinically important systemic consequences. For an appropriate diagnosis and follow up a multidimensional evaluation of the disease is required including: degree of airway obstruction, lung hyperinflation, dyspnea, exercise capacity, quality of life and nutritional status. The influence of gender on the clinical expression of COPD has received limited attention. The lack of information regarding gender and COPD is surprising, because according to the recent COPD disease surveillance in the United States [1], for the first time in 2002, the number of women dying from this disease surpassed that of men. Quality of Life has become an important measurable outcome in patients with Chronic Obstructive Pulmonary Disease (COPD). It is known to predict mortality [2], hospitalization [3], health care resource utilization [3] and response to different treatment options [4]. The Saint George's Respiratory Questionnaire (SGRQ) has become one of the most widely used health-related specific questionnaires for assessing QoL in respiratory patients [5]. In the literature there are few reports suggesting a greater impairment in health related quality of life in female patients with COPD [6-10]. Several studies completed mainly in men with COPD, have explored the physiological and psychological factors associated with QoL impairment [11-14]. They have shown that dyspnea, six minute walk distance (6MWD), PaO2, FEV1, anxiety and depression are associated with the QoL scores in these patients. In a previous study [15], we found that in a FEV1% matched population of COPD patients, women had worse SGRQ scores than men at younger age and earlier stage of the disease. We planned the present study in a larger sample, to explore possible gender differences in the factors associated and predictive of SGRQ scores in both genders. Methods This FEV1 matched case series study, recruited COPD patients attending the pulmonary clinic at Hospital Universitario Ntra Sra de Candelaria, a tertiary public university hospital in Spain from January 2000 to December 2005. We recruited 73 consecutive women attending the clinic and then matched 73 patients with similar degree of airflow obstruction randomly selected from our much la (...truncated)


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Juan P de Torres, Ciro Casanova, Concepción Hernández, Juan Abreu, Angela Montejo de Garcini, Armando Aguirre-Jaime, Bartolome R Celli. Gender associated differences in determinants of quality of life in patients with COPD: a case series study, Health and Quality of Life Outcomes, 2006, pp. 72, 4, DOI: 10.1186/1477-7525-4-72