Clinical Outcomes in Chronic Obstructive Pulmonary Disease Are Associated With Perception of Dyspnea More Than Exacerbation Risk or Disease Severity Measured by Lung Function

Abstract SESSION TYPE: COPD: Severity and Risk PredictorsPRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PMPURPOSE: In December 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Executive committee published revised recommendations for the classification and assessment of COPD patients. The new grading system is based on symptoms, exacerbations risk (AECOPD) within the last year, and lung function. The purpose of this study was to examine which factors from the new grading system were most closely associated with quality of life, functional status, and depression in COPD patients.METHODS: Cross-sectional analysis from an ongoing longitudinal observational study of depression in COPD. Patients completed spirometry, Modified Medical Research Council (MRC) dyspnea scale, questions related to AECOPD within the last year, chronic respiratory questionnaire (CRQ), depression interview (Personal Health Questionnaire, PHQ-9), and six-minute walk test (6MWT) at study entry. We categorized participants into the 4 new GOLD categories (Grade A-D). We used Analysis of variance and Chi-squared tests for continuous and categorical variables, respectively.RESULTS: A total of 158 COPD patients were included in the analysis (age: 66±9 years; 22% females; forced expiratory volume in 1 second (FEV1) %predicted of 41±16%; mean number of AECOPD within the last year = 1.03; MRC=2.0±-1.14. The percentage of patients in each grade was: A: 18%, B: 9%, C: 22%, D: 51%. The CRQ was significantly higher for Grades A and C (105±17.7 and 98±20, respectively) than for Grades B and D (80±19 and 84±22, respectively) (palt;0.001). The 6MWT distance was also higher for Grades A and C than for Grades B and D (palt;0.001). Although depression history was similar across all Grades (p=0.32), more Grades B and D patients had high depression scores (PHQ-9 ≥10) than those in Grades A and C (p=0.04).CONCLUSIONS: In patients with COPD, perception of dyspnea was more associated with quality of life, functional status and depression than was disease severity based on spirometry and exacerbations risk.CLINICAL IMPLICATIONS: Systematically assessing dyspnea in COPD patients is important since perception of dyspnea is a driving factor in clinical outcomes.DISCLOSURE: Sandra Adams: Grant monies (from sources other than industry): Chest Foundation, NIH, VA Cooperative Studies Program, Grant monies (from industry related sources): Bayer, Boehringer Ingelheim, Centocor, GSK, Novartis, Pfizer, Schering Plough, Other: Honoraria for Speaking (Unrestricted Grants for Continuing Education): ABComm, Altana, AstraZeneca Pharmaceuticals LP; Aventis, Bayer Pharmaceuticals Corp; Boehringer Ingelheim Pharmaceuticals, Inc; GlaxoSmithKline; Novartis Pharmaceuticals AG; Nycomed, Pfizer Inc; Schering-Plough CorpVincent Fan: Grant monies (from sources other than industry): NIH, Veterans Administration, Consultant fee, speaker bureau, advisory committee, etc.: Uptake MedicalHuong Nguyen: Grant monies (from sources other than industry): NIH, CDC, VASoo Borson: Grant monies (from sources other than industry): NIHRuth Kohen: Grant monies (from sources other than industry): NIHGustavo Matute-Bello: Grant monies (from sources other than industry): NIHGenevieve Pagalilauan: Other: Writes Practical Reviews of Internal Medicine for Oakstone PublishingAntonio Anzueto: Grant monies (from sources other than industry): NIH, NHLBI, Grant monies (from industry related sources): GSK, Consultant fee, speaker bureau, advisory committee, etc.: GSK, BI, Forest, Dey, Other: Member of the GOLD Executive and scientific committeeNo Product/Research Disclosure InformationUTHSCSA/STVHCS, San Antonio, TX.