Cough and phlegm are important predictors of health status in smokers without COPD.
OBJECTIVE
The health-related quality of life of smokers without COPD and that of ex-smokers has not been defined. If abnormal, the role of small airways disease and that of cough and phlegm have never been evaluated. Therefore, the aim of the study was to explore whether the differences in quality of life between smokers and ex-smokers could be explained by cough and phlegm, differences in pulmonary function tests, or exercise capacity.


METHODS
Observational, prospective.


METHODS
Pulmonary and Critical Care Division, COPD Center at St. Elizabeth's Medical Center.


METHODS
In 36 smokers, 21 ex-smokers (stopped smoking for > 20 years), 19 never-smokers with normal FVC and FEV(1) values, and 41 patients with COPD (FEV(1) 38 +/- 11% predicted [mean +/- SD]), the St. George's Respiratory Questionnaire (SGRQ), pulmonary function tests, and a 6-min walk distance (6MWD) were performed.


RESULTS
The total SGRQ scores were worse in current smokers (15 +/- 15) than in ex-smokers (6 +/- 4) or never-smokers (4 +/- 3) [p < 0.05]. As expected, the worst score was seen in COPD (50 +/- 15). After correcting for cough and phlegm, the difference in SGRQ scores between smokers and ex-smokers disappeared. In current and ex-smokers, the SGRQ score was associated with the exposure to pack-years smoking history (r = 0.45, p < 0.01, and r = 0.83, p < 0.0001, respectively) but independent of lung function or exercise parameters (6MWD).


CONCLUSIONS
In smokers without COPD, the abnormal SGRQ score is due to the noxious effect of cigarette smoke, resulting in cough and phlegm, independent of its physiologic effects.
Heijdra
Yvonne F
YF
Pulmonary Department, University Medical Center, St. Radboud, Nijmegen, The Netherlands.
Pinto-Plata
Victor M
VM
Kenney
Lawrence A
LA
Rassulo
John
J
Celli
Bartolome R
BR
D000368:Aged; D003371:Cough / Q000209:etiology*; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006801:Humans; D008297:Male; D008450:Maximal Midexpiratory Flow Rate; D008875:Middle Aged; D009093:Mucus / Q000378:metabolism*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D011788:Quality of Life; D012129:Respiratory Function Tests; D012907:Smoking / Q000009:adverse effects* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014797:Vital Capacity