What Determines Subjective Health Status in Patients With COPD
What Determines Subjective Health Status in Patients With COPD
Background: Subjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV1%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health.
Methods: This study had a cross-sectional design, and included 100 COPD patients (51% men, mean age 66.1 years). Lung function was assessed by predicted FEV1%, oxygen saturation by transcutaneous pulse oximeter, symptoms with the St George Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, physical function with the Incremental Shuttle Walking Test, and subjective health status with the SF-36 health survey. Linear regression analysis was used.
Results: Older patients reported less breathlessness and women reported more anxiety (p < 0.050). Women, older patients, those with lower predicted FEV1%, and those with greater depression had lower physical function (p < 0.050). Patients with higher predicted FEV1%, those with more breathlessness, and those with more anxiety or depression reported lower subjective health status (p < 0.050). Symptoms explained the greatest variance in subjective health status (35%-51%).
Conclusion: Symptoms are more important for the subjective health status of patients with COPD than demographics, physiological variables, or physical function. These findings should be considered in the treatment and care of these patients.
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by impairment of lung function with airway obstruction, which is most frequently the result of tobacco smoke. COPD is one of the major causes of morbidity and mortality worldwide. Many people suffer from this disease for years and die from it or its complications. Hoogendoorn et al. estimated that the prevalence of diagnosed COPD, the number of deaths, and the associated health costs will increase during the next decade. In addition to the social strain, COPD also influences the patients' symptoms, function, and subjective health status.
An important issue in understanding the complexity of COPD as an illness and thereby its management, is what determines the subjective health status of these patients. Wilson and Cleary suggested a model that clarified the relationships between biological and physiological variables, symptoms, function, general health perception, and overall quality of life, and the impact of the characteristics on individuals and their environments. This model indicated that biological and physiological processes affect the perception of symptoms, which in turn affects function, general health perception, and overall quality of life. However, these authors point out that this main causal direction in their model does not imply that there are not reciprocal relationships.
Several studies of COPD patients have examined different associations between physiological variables, symptoms, physical function, and subjective health status. For example, de Torres et al. investigated differences in physiological factors and sex, and reported that women have better oxygen saturation than men. In terms of symptoms, studies of COPD patients have shown that higher oxygen consumption is associated with improved mood, and lower predicted FEV1% is associated with more breathlessness. Furthermore Cleland et al found that older COPD patients report less anxiety and depression than younger. Anderson found that greater depression is associated with lower physical function. With regard to subjective health status, studies have reported that women suffering from COPD and older COPD patients report worse physical health. Other studies have reported that lower predicted FEV1% and functional exercise capacity and greater anxiety and depression are associated with lower subjective health status.
The abovementioned studies mainly investigated bivariate relationships between demographics, physiological variables, symptoms, physical function, and subjective health status, but lack a multivariate perspective on subjective health status in COPD. According to the biopsychosocial perspective, subjective health status cannot be explained by biological and physiological factors alone. Instead, subjective health status is the result of an interaction between physiological and psychosocial factors. COPD is a chronic disease, which must be managed rather than cured. Therefore, knowledge about what determines subjective health status in this group of patients is relevant for the treatment of COPD, and for the care and rehabilitation of patients. To this end, the aim of the present study was to explore the determinants of subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV1%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health. Based on previous studies in COPD patients and the conceptual model of Wilson and Cleary, the following conceptual model is postulated (Figure 1).
(Enlarge Image)
Figure 1.
A proposed model for the relationships between demographics, physiological variables, symptoms, physical function and subjective health status
Abstract
Background: Subjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV1%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health.
Methods: This study had a cross-sectional design, and included 100 COPD patients (51% men, mean age 66.1 years). Lung function was assessed by predicted FEV1%, oxygen saturation by transcutaneous pulse oximeter, symptoms with the St George Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, physical function with the Incremental Shuttle Walking Test, and subjective health status with the SF-36 health survey. Linear regression analysis was used.
Results: Older patients reported less breathlessness and women reported more anxiety (p < 0.050). Women, older patients, those with lower predicted FEV1%, and those with greater depression had lower physical function (p < 0.050). Patients with higher predicted FEV1%, those with more breathlessness, and those with more anxiety or depression reported lower subjective health status (p < 0.050). Symptoms explained the greatest variance in subjective health status (35%-51%).
Conclusion: Symptoms are more important for the subjective health status of patients with COPD than demographics, physiological variables, or physical function. These findings should be considered in the treatment and care of these patients.
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by impairment of lung function with airway obstruction, which is most frequently the result of tobacco smoke. COPD is one of the major causes of morbidity and mortality worldwide. Many people suffer from this disease for years and die from it or its complications. Hoogendoorn et al. estimated that the prevalence of diagnosed COPD, the number of deaths, and the associated health costs will increase during the next decade. In addition to the social strain, COPD also influences the patients' symptoms, function, and subjective health status.
An important issue in understanding the complexity of COPD as an illness and thereby its management, is what determines the subjective health status of these patients. Wilson and Cleary suggested a model that clarified the relationships between biological and physiological variables, symptoms, function, general health perception, and overall quality of life, and the impact of the characteristics on individuals and their environments. This model indicated that biological and physiological processes affect the perception of symptoms, which in turn affects function, general health perception, and overall quality of life. However, these authors point out that this main causal direction in their model does not imply that there are not reciprocal relationships.
Several studies of COPD patients have examined different associations between physiological variables, symptoms, physical function, and subjective health status. For example, de Torres et al. investigated differences in physiological factors and sex, and reported that women have better oxygen saturation than men. In terms of symptoms, studies of COPD patients have shown that higher oxygen consumption is associated with improved mood, and lower predicted FEV1% is associated with more breathlessness. Furthermore Cleland et al found that older COPD patients report less anxiety and depression than younger. Anderson found that greater depression is associated with lower physical function. With regard to subjective health status, studies have reported that women suffering from COPD and older COPD patients report worse physical health. Other studies have reported that lower predicted FEV1% and functional exercise capacity and greater anxiety and depression are associated with lower subjective health status.
The abovementioned studies mainly investigated bivariate relationships between demographics, physiological variables, symptoms, physical function, and subjective health status, but lack a multivariate perspective on subjective health status in COPD. According to the biopsychosocial perspective, subjective health status cannot be explained by biological and physiological factors alone. Instead, subjective health status is the result of an interaction between physiological and psychosocial factors. COPD is a chronic disease, which must be managed rather than cured. Therefore, knowledge about what determines subjective health status in this group of patients is relevant for the treatment of COPD, and for the care and rehabilitation of patients. To this end, the aim of the present study was to explore the determinants of subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV1%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health. Based on previous studies in COPD patients and the conceptual model of Wilson and Cleary, the following conceptual model is postulated (Figure 1).
(Enlarge Image)
Figure 1.
A proposed model for the relationships between demographics, physiological variables, symptoms, physical function and subjective health status
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