Health & Medical Respiratory Diseases

Change in Quality of Life After Acute Exacerbations of COPD

´╗┐Change in Quality of Life After Acute Exacerbations of COPD

Background


Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are often accompanied by a decline in an individual's quality of life (QoL). While recovery following AECOPD managed without hospital admission may be unpredictable and prolonged, the time course of recovery following hospitalisation for AECOPD has been infrequently studied and requires clarification.

Clinical guidelines recommend that patients whose QoL is "unlikely to recover to an acceptable level" should not receive assisted ventilation when otherwise indicated. Implicit in this statement is an assumption that both clinicians and patients can make a reasonable estimate of what an individual's QoL and functional status will be if they survive the acute admission. However, evidence on this point is sparse, with only a single longitudinal study, which suggested that QoL measurements may continue to recover for up to 9 months following hospital discharge.

Despite the prognostic uncertainty, some patients do not receive assisted ventilation because either they or their clinicians expect their QoL and/or functional status to be unacceptably poor following hospital discharge. Nava et al surveyed end-of-life decision-making in respiratory critical care units across Europe and rated the reasons for withholding or withdrawing treatment on a scale of 1 (most important) to 10 (least important). They showed that predictions of a poor QoL following discharge (specifically, a poor predicted functional status or assumption by the patient that their QoL postdischarge would be unacceptable) were between the second and fourth most common reasons for limiting treatment. As recommended, therefore, important treatment decisions are being made on the basis of clinicians' and patients' predictions of postdischarge QoL and functional status with very little evidence that such predictions are accurate.

In order to clarify the long-term effects on QoL of hospitalisation for AECOPD, we have performed sequential assessments of surviving patients, both those who required and did not require assisted ventilation, over 12 months following discharge.

'Quality of life' is a broad multidimensional concept which includes evaluation of both positive and negative aspects of life. Psychological well-being, functional status, general health-related QoL (HRQoL) and respiratory-specific HRQoL are all domains of overall QoL. The definitions of these domains vary in the literature and there is terminological confusion. The assessment tools used in this study aim to evaluate each of these domains individually but they will also be influenced by general changes in individuals' lives (eg, bereavement, unemployment, medical conditions). Consequently, due to terminological uncertainty and the lack of specificity of the individual tools, we have chosen to use the general term 'quality of life' to describe the changes in HRQoL, psychological well-being and functional status that participants experienced.

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