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Independent determinants of disease-related quality of life in COPD – scope for nonpharmacologic interventions?

Authors Brien SB, Stuart B, Dickens AP, Kendrick T, Jordan RE, Adab P, Thomas M

Received 30 September 2017

Accepted for publication 10 November 2017

Published 9 January 2018 Volume 2018:13 Pages 247—256


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Sarah B Brien,1 Beth Stuart,1 Andrew P Dickens,2 Tony Kendrick,1 Rachel E Jordan,2 Paymane Adab,2 Mike Thomas1

1Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, 2Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Warwickshire, UK

Purpose: Quality-of-life (QoL) scores in chronic obstructive pulmonary disease (COPD) have a weak relationship with physiologic impairment. We investigated factors associated with poor QoL, focusing on psychological measures potentially amenable to intervention.
Patients and methods: We utilized a pre-existing Birmingham (UK) COPD cohort to assess factors associated with QoL impairment (COPD Assessment Test [CAT] scores). Univariate and multivariate regression models were constructed from three categories of variables: demographic, lung function/COPD-related symptoms, and psychosocial/behavioral factors.
Results: Analyses were based on self-report questionnaire data from 735 participants. The multivariate model of variables independently associated with CAT included depression, dysfunctional breathing symptoms (Nijmegen score), and illness perception, in addition to COPD symptoms (wheeze, cough), exercise capacity, breathlessness, exacerbations, and deprivation; this model explained 72% of CAT score variation. In a dominance analysis assessing the relative contribution of variables, similar contributions were made by breathlessness (20.2%), illness perception (19.8%), dysfunctional breathing symptoms (17.5%), and depression (12.5%) with other variables contributing <5%.
Conclusion: Psychological factors significantly contribute to disease-specific QoL impairment in COPD, and potentially explain the mismatch between objective physiologic impairment and patients’ experience of their disease. Interventions targeting psychological factors, illness perception, and dysfunctional breathing should be assessed.

Keywords: chronic obstructive pulmonary disease, quality of life, health status, survey, psychological, dysfunctional breathing, breathlessness, illness perception, depression

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