title: Quality of life in smokers: focus on functional limitations rather than on lung function?
abstract: BACKGROUND
  The Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of severity of chronic obstructive pulmonary disease (COPD) is based solely on obstruction and does not capture physical functioning. The hypothesis that the Medical Research Council (MRC) dyspnoea scale would correlate better with quality of life than the level of airflow limitation was examined.
  
  
  OBJECTIVE
  To study the associations between quality of life in smokers and limitations in physical functioning (MRC dyspnoea scale) and, quality of life and airflow limitation (GOLD COPD stages).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  The city of IJsselstein, a small town in the centre of The Netherlands.
  
  
  METHODS
  Male smokers aged 40-65 years without a prior diagnosis of COPD and enlisted with a general practice, participated in this study. Quality of life was assessed by means of a generic (SF-36) and a disease-specific, questionnaire (QOLRIQ).
  
  
  RESULTS
  A total of 395 subjects (mean age 55.4 years, pack years 27.1) performed adequate spirometry and completed the questionnaires. Limitations of physical functioning according to the MRC dyspnoea scale were found in 25.1% (99/395) of the participants and airflow limitation in 40.2% (159/395). The correlations of limitations of physical functioning with all quality-of-life components were stronger than the correlations of all quality-of-life subscales with the severity of airflow limitation.
  
  
  CONCLUSIONS
  In middle-aged smokers the correlation of limitations of physical functioning (MRC dyspnoea scale) with quality of life was stronger than the correlation of the severity of airflow limitation with quality of life. Future staging systems of severity of COPD should capture this and not rely on forced expiratory volume in one second (FEV1) alone.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands. rmmgeyer@hotmail.com
authors.forename: Roeland Mm
authors.initials: RM
authors.lastname: Geijer
authors.forename: Alfred Pe
authors.initials: AP
authors.lastname: Sachs
authors.forename: Theo Jm
authors.initials: TJ
authors.lastname: Verheij
authors.forename: Huib Am
authors.initials: HA
authors.lastname: Kerstjens
authors.forename: Marijke M
authors.initials: MM
authors.lastname: Kuyvenhoven
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D011788:Quality of Life; D012720:Severity of Illness Index; D012907:Smoking / Q000503:physiopathology; D014797:Vital Capacity / Q000502:physiology