Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of life
Background The life trajectory of chronic obstructive pulmonary disease (COPD) remains unknown.Patients and methods We collected data from two populations. In the first cohort, we recruited 375 patients with COPD from our hospital, and 1440 repeated assessments of quality of life (QoL) using the Eur...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-02-01
|
| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/11/1/e002037.full |
| _version_ | 1797300288073236480 |
|---|---|
| author | Jung-Der Wang Chiung-Zuei Chen Pei-Fang Su Xin-Min Liao Sheng-Han Tsai Jo-Ying Hung Chih-Hui Hsu Chun-Hsiang Yu Tzuen-Ren Hsiue |
| author_facet | Jung-Der Wang Chiung-Zuei Chen Pei-Fang Su Xin-Min Liao Sheng-Han Tsai Jo-Ying Hung Chih-Hui Hsu Chun-Hsiang Yu Tzuen-Ren Hsiue |
| author_sort | Jung-Der Wang |
| collection | DOAJ |
| description | Background The life trajectory of chronic obstructive pulmonary disease (COPD) remains unknown.Patients and methods We collected data from two populations. In the first cohort, we recruited 375 patients with COPD from our hospital, and 1440 repeated assessments of quality of life (QoL) using the European Quality of Life-5 Dimensions questionnaire from 2006 to 2020. We analysed their dynamic changes using the kernel-smoothing method. The second cohort comprised 27 437 patients from the National Health Insurance (NHI) dataset with their first severe acute exacerbations (AEs) requiring hospitalisation from 2008 to 2017 were analysed for their long-term course of AEs. We employed a Cox hazard model to analyse the predictors for mortality or AEs.Results Cohorts from our hospital and NHI were male predominant (93.6 and 83.5%, respectively). After the first severe AE, the course generally comprised three phases. The first was a 1-year period of elevated QoL, followed by a 2-year prolonged stable phase with a slowly declining QoL. After the second AE, the final phase was characterised by a rapid decline in QoL. For NHI cohort, 2712 died during the 11-year follow-up, the frequency of the first AE was approximately 5 per 10 000 per day. The median time from the first to the second AE was 3 years, which decreased to less than 6 and 3 months from 4th to 5th and 8th to 9th AE, respectively. The frequency of AE was increased 10-fold and 15-fold and risk of subsequent AE was increased 12-fold and 20-fold after the 6th and the 10th AE, relative to the first. Male gender, heart failure comorbidities were associated with the risk of subsequent AE and death.Conclusions The life trajectory of COPD includes the accelerated frailty phase, as well as elevated health and prolonged stable phase after the first AE. |
| first_indexed | 2024-03-07T23:04:07Z |
| format | Article |
| id | doaj.art-60354560b4d44c3c8a1f6368c2939957 |
| institution | Directory Open Access Journal |
| issn | 2052-4439 |
| language | English |
| last_indexed | 2024-03-07T23:04:07Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj.art-60354560b4d44c3c8a1f6368c29399572024-02-22T06:05:08ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392024-02-0111110.1136/bmjresp-2023-002037Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of lifeJung-Der Wang0Chiung-Zuei Chen1Pei-Fang Su2Xin-Min Liao3Sheng-Han Tsai4Jo-Ying Hung5Chih-Hui Hsu6Chun-Hsiang Yu7Tzuen-Ren Hsiue89Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan1 Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanCenter for Quantitative Sciences, Clinical Medicine Research Center, National Cheng Kung University Hospital, Tainan, TaiwanDepartment of Internal Medicine, National Cheng Kung University Hospital, Tainan, TaiwanDivision of General Medicine, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Statistics, National Cheng Kung University, Tainan, TaiwanClinical Medicine Research Center, National Cheng Kung University Hospital, Tainan, TaiwanDivision of Pulmonary Medicine, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, TaiwanDivision of Pulmonary Medicine, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, TaiwanBackground The life trajectory of chronic obstructive pulmonary disease (COPD) remains unknown.Patients and methods We collected data from two populations. In the first cohort, we recruited 375 patients with COPD from our hospital, and 1440 repeated assessments of quality of life (QoL) using the European Quality of Life-5 Dimensions questionnaire from 2006 to 2020. We analysed their dynamic changes using the kernel-smoothing method. The second cohort comprised 27 437 patients from the National Health Insurance (NHI) dataset with their first severe acute exacerbations (AEs) requiring hospitalisation from 2008 to 2017 were analysed for their long-term course of AEs. We employed a Cox hazard model to analyse the predictors for mortality or AEs.Results Cohorts from our hospital and NHI were male predominant (93.6 and 83.5%, respectively). After the first severe AE, the course generally comprised three phases. The first was a 1-year period of elevated QoL, followed by a 2-year prolonged stable phase with a slowly declining QoL. After the second AE, the final phase was characterised by a rapid decline in QoL. For NHI cohort, 2712 died during the 11-year follow-up, the frequency of the first AE was approximately 5 per 10 000 per day. The median time from the first to the second AE was 3 years, which decreased to less than 6 and 3 months from 4th to 5th and 8th to 9th AE, respectively. The frequency of AE was increased 10-fold and 15-fold and risk of subsequent AE was increased 12-fold and 20-fold after the 6th and the 10th AE, relative to the first. Male gender, heart failure comorbidities were associated with the risk of subsequent AE and death.Conclusions The life trajectory of COPD includes the accelerated frailty phase, as well as elevated health and prolonged stable phase after the first AE.https://bmjopenrespres.bmj.com/content/11/1/e002037.full |
| spellingShingle | Jung-Der Wang Chiung-Zuei Chen Pei-Fang Su Xin-Min Liao Sheng-Han Tsai Jo-Ying Hung Chih-Hui Hsu Chun-Hsiang Yu Tzuen-Ren Hsiue Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of life BMJ Open Respiratory Research |
| title | Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of life |
| title_full | Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of life |
| title_fullStr | Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of life |
| title_full_unstemmed | Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of life |
| title_short | Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of life |
| title_sort | chronic obstructive pulmonary disease trajectory severe exacerbations and dynamic change in health related quality of life |
| url | https://bmjopenrespres.bmj.com/content/11/1/e002037.full |
| work_keys_str_mv | AT jungderwang chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife AT chiungzueichen chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife AT peifangsu chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife AT xinminliao chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife AT shenghantsai chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife AT joyinghung chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife AT chihhuihsu chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife AT chunhsiangyu chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife AT tzuenrenhsiue chronicobstructivepulmonarydiseasetrajectorysevereexacerbationsanddynamicchangeinhealthrelatedqualityoflife |