Chronic Bronchitis Is Associated With Worse Symptoms and Quality of Life Than Chronic Airflow Obstruction.
BACKGROUND
COPD includes the chronic bronchitis (CB) and emphysema phenotypes. Although it is generally assumed that emphysema or chronic airflow obstruction (CAO) is associated with worse quality of life (QOL) than is CB, this assumption has not been tested.


METHODS
The current study's analyses from the Lovelace Smokers' Cohort (LSC) were validated in the COPD Gene Cohort (COPDGene). CB without CAO (CB only) was defined as self-reported cough productive of phlegm for ≥ 3 mo/y for 2 consecutive years and postbronchodilator FEV1/FVC ≥ 70%. CAO without CB (CAO only) was defined as a postbronchodilator FEV1/FVC < 70% with no evidence of CB. QOL outcomes were obtained from the St. George's Respiratory Questionnaire (SGRQ) and the 36-Item Short Form Health Survey (SF-36) questionnaires. A priori covariates included age, sex, pack-years of smoking, current smoking, and FEV1.


RESULTS
Smokers with CB without CAO (LSC = 341; COPDGene = 523) were younger and had a greater BMI and less smoking exposure than did those with CAO only (LSC = 302; COPDGene = 2,208). Compared with the latter group, QOL scores were worse for those with CB only. Despite similar SGRQ Activity and SF-36 Role Physical and Physical Functioning, SGRQ Symptoms and Impact scores and SF-36 emotional and social measures were worse in the CB-only group, in both cohorts. After adjustment for covariates, the CB-only group remained a significant predictor for "worse" symptoms and emotional and social measures.


CONCLUSIONS
To our knowledge, this analysis is the first to suggest that among subjects with COPD, those with CB only present worse QOL symptoms and mental well-being than do those with CAO only.
College of Nursing, University of Colorado-Denver, Denver, CO.
Paula M
PM
Meek
COPD Research Program, Lovelace Respiratory Research Institute, Albuquerque, NM.
Hans
H
Petersen
Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
George R
GR
Washko
Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Alejandro A
AA
Diaz
Temple University School of Medicine, Philadelphia, PA.
Victor
V
Klm
Department of Internal Medicine, University of New Mexico, Albuquerque, NM.
Akshay
A
Sood
COPD Research Program, Lovelace Respiratory Research Institute, Albuquerque, NM. Electronic address: ytesfaig@lrri.org.
Yohannes
Y
Tesfaigzi
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D029481:Bronchitis, Chronic / Q000503:physiopathology* / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D012720:Severity of Illness Index