title: Greater dyspnea is associated with lower health-related quality of life among European patients with COPD.
abstract: OBJECTIVE
  Dyspnea is a defining symptom in the classification and treatment of chronic obstructive pulmonary disease (COPD). However, the degree of variation in burden among symptomatic COPD patients and the possible correlates of burden remain unclear. This study was conducted to characterize patients in Europe currently being treated for COPD according to the level of dyspnea in terms of sociodemographics, health-related quality of life, work productivity impairment, and health care resource use assessed by patient reports.
  
  
  METHODS
  Data were derived from the 5-EU 2013 National Health and Wellness Survey (N=62,000). Respondents aged ≥40 years who reported currently using a prescription for COPD were grouped according to their level of dyspnea as per the Global Initiative for Chronic Obstructive Lung Disease guidelines and compared on health status (revised Short Form 36 [SF-36]v2), work impairment (Work Productivity and Activity Impairment questionnaire), and number of health care visits in the past 6 months using generalized linear models with appropriate distributions and link functions.
  
  
  RESULTS
  Of the 768 respondents who met the inclusion criteria, 245 (32%) were considered to have higher dyspnea (equivalent to modified Medical Research Council score ≥2). Higher dyspnea was associated with decrements ranging from 3.9 to 8.2 points in all eight domains of the SF-36 health profile after adjustment for sociodemographics, general health characteristics, and length of COPD diagnosis; mental component summary scores and Short Form-6D health utility scores were lower by 3.5 and 0.06 points, respectively. Adjusted mean activity impairment (55% vs 37%,P<0.001) and number of emergency room visits (0.61 vs 0.40,P=0.030) were higher in patients with greater dyspnea.
  
  
  CONCLUSIONS
  Many European patients with COPD continue to experience dyspnea despite treatment and at levels associated with notable impairments in the patients' ability to function across a multitude of domains. These patients may benefit from more intense treatment of their symptoms.
authors.affiliation: Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Basel-Stadt, Switzerland.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Gruenberger
authors.affiliation: Health Outcomes Practice, Kantar Health, Horsham, PA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Vietri
authors.affiliation: Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Basel-Stadt, Switzerland.
authors.forename: Dorothy L
authors.initials: DL
authors.lastname: Keininger
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Mahler
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017281:Cost of Illness; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D004526:Efficiency; D004651:Employment; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D018582:Sick Leave; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation
keywords: COPD; activity impairment; dyspnea; health-related quality of life; symptoms