title: Exacerbation-related impairment of quality of life and work productivity in severe and very severe chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Exacerbation-associated health-related quality of life (HRQoL) in patients with severe and very severe chronic obstructive pulmonary disease (COPD) is ill-defined. This study describes patterns, HRQoL, and the work productivity impact of COPD-related moderate and SEV exacerbations in patients with SEV/VSEV COPD, focusing on the chronic bronchitis subtype.
  
  
  METHODS
  A US sample of SEV and VSEV COPD patients with recent moderate or SEV exacerbation was recruited. Along with the demographic and clinical data collected from medical records, patients reported on exacerbation frequency, health-related quality of life (HRQoL) (using the St George's Respiratory Questionnaire for COPD [SGRQ-C] and the European Quality of Life-5 Dimensions [EQ-5D]™ index), and work productivity and activity impairment (using the Work Productivity and Activity Impairment Questionnaire - Specific Health Problem [WPAI-SHP]). The HRQoL-related impacts of exacerbation frequency, time since exacerbation, and last exacerbation severity were evaluated via linear regressions.
  
  
  RESULTS
  A total of 314 patients (190 SEV/124 VSEV, mean age =68.0 years, 51% male, 28% current smokers) were included. In the previous 12 months, patients reported an average of 1.8 moderate exacerbations and 0.9 SEV exacerbations. Overall, 16% of patients were employed and reported a high percentage of overall work impairment (42.4% ± 31.1%). Activity impairment was positively associated with recent exacerbation severity (SEV 64.6% ± 26.8% versus moderate 55.6% ± 28.2%) (P=0.006). The HRQoL was significantly worse for SEV versus VSEV COPD (EQ-5D: 0.62 ± 0.23 versus 0.70 ± 0.17, respectively, and SGRQ-C: 70.1 ± 21.3 versus 61.1 ± 19.0, respectively) (P<0.001). Worse current HRQoL was reported by patients with a SEV versus moderate recent exacerbation (EQ-5D: 0.63 ± 0.21 versus 0.70 ± 0.20, respectively) (P=0.003); SGRQ-C: 70.3 ± 19.9 versus 61.7 ± 20.1, respectively (P<0.001). One additional exacerbation in the previous 12 months was associated with a 2.4-point SGRQ-C increase and a 0.02-point EQ-5D index decrease.
  
  
  CONCLUSIONS
  The severity and frequency of COPD-related moderate/SEV exacerbations in SEV and VSEV COPD patients were positively associated with poor HRQoL and work productivity and activity impairment.
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Caitlyn T
authors.initials: CT
authors.lastname: Solem
authors.affiliation: Forest Research Institute, Jersey City, NJ, USA.
authors.forename: Shawn X
authors.initials: SX
authors.lastname: Sun
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Lavanya
authors.initials: L
authors.lastname: Sudharshan
authors.affiliation: Medical Data Analytics, Parsippany, NJ, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Macahilig
authors.affiliation: Medical Data Analytics, Parsippany, NJ, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Katyal
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004526:Efficiency; D004651:Employment; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014938:Work Capacity Evaluation
keywords: HRQoL; burden; chronic obstructive pulmonary disease; exacerbations; health-related quality of life; utilities