Quality of Life for Adult Patients with Chronic Obstructive Pulmonary Disease

: Objective


Introduction
he chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world.Many people suffer from this disease for years and die prematurely from it or its complications (1) .COPD is a disease state characterized by airway limitation that is not fully reversible.The high burden of COPD resulting from coughing, sputum production and shortness of breath, is further contributed to by systemic effects, leading to a pronounced deterioration in health status and a diminished quality of life (2)(3).In COPD patients, the airflow limitation leads to reduce the capacity for function activities and decrease the performance of daily activities, and ultimately impairment in the quality of life (4) .
Exacerbations of COPD are associated with considerable physiologic deterioration and increased airway inflammatory changes that are caused by various factors such as viruses, bacteria, and possibly common pollutants (5) .Acute exacerbations are a common reason for hospital admissions and affect health-related quality of life (HRQL) and prognosis (6) .The researcher stated that the interest in HRQOL over the past decade has increased substantially because of the recognition of the following factors: (1) individual pa ents are most concerned about their symptoms (e.g., dyspnea) and their functions (e.g., ability to perform physical tasks), rather than objective measures such as expiratory airflow; (2) HRQOL is a unique construct that is different from physiologic measures or survival; and (3) the goals of therapy have been expanded to include the relief of symptoms and improvement in HRQOL, in addition to the standard physiologic outcomes.

Methodology
A descriptive study was carried out to determine the quality of life for adult patients with chronic obstructive pulmonary disease in Baghdad city.The study was initiated from December 2008 through October 2009.A purposive "non-probability" sample was selected of (80) pa ents who were admitted to hospital with pervious diagnosis of COPD attended to Baghdad Teaching Hospital and Al-Yarmuk teaching hospital.The study was conducted on the patients with chronic obstructive pulmonary diseases who attended the respiratory clinic.A questionnaire was constructed for the purpose of the study throughout the review of relevant literature.The questionnaire consists of three parts; part-1 socio-demographic characteristics, part-2 medical data, part-3 quality of life scale.The investigator adopted and developed QOL domain according to World Health Organization (WHO) scale and St. George's respiratory questionnaire which the investigator adapted to measure physical domain (symptoms of disease), which are concerned with measurement of QOL on rating scoring type likert scale it is scored as 1 for never, 2 for always.So, the cut-off-point was two.To determine the quality of life for COPD, accumulative score was obtained according to previous likert score and presented as acceptable and good, poor quality of life.The data were analyzed through the application of descriptive data analysis approach which included frequency, percentage, standard deviation, mean and mean of scores and inferential data approach (T-test, ANOVA, correlation coefficient).This table shows that the highest percentage (66.2%) of COPD pa ents was male, (63.7%) at the age group of (50-59) and (60-69) years.Concerning the marital status, the highest percentage (72.5) of COPD pa ents were married.Regarding the level of education the highest percentage (47.5%)was unable to read and write.Concerning the occupational status before disease, the results show that the highest percentages (56.2 %) were self-employed and none of patients was unemployed while most (65.0%) of COPD pa ents a er disease were unemployed.Regarding to income the results revealed that the (43.8%) were not sufficient.

Results:
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)This table shows that the highest percentages (61.3%) of the sample were pervious smoking and most of them (65.0%) were smoking.Regarding to the number of cigarettes per day, the highest percentage (68.3%) of sample smoked one pack per day.Regarding to the duration of smoking the results shows that the highest percentages (36.7%) of pa ents were smoking 20-29 years ago and (69.6%) lives with smoking people.Table (2) shows that the highest percentages (56.2%) of COPD patients' duration of disease were (2-5) years.Regarding to the times of hospitalization, the data show that the highest percentage (56.2%) of sample were1-2 time.The table also shows that the highest percentage (65.0%) of pa ents hasn't in the family history any COPD and the highest percentages (57.1%) of the rela ves who have COPD were fathers.Regarding to the body mass index, the data show that the highest percentages (53.8%) of the sample were overweight.According to the severity of disease, the result shows that the highest percentages (38.8%) were moderate (FEV1/FVC less 70 %and FEV1 % less than 50 % -80%).This table demonstrates that there is no significant differences between smoking status and QOL domains, except type of smoking there is significant differences between QOL with COPD p< (0.001).
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)This table demonstrates that there are no significant differences between clinical characteristics and QOL domains, except history of COPD there is significant between QOL with COPD p< (0.023).

Discussion:
The aims in treatment of COPD are to decrease the rate of disease progression and of exacerbations, to ameliorate the symptoms, to improve the performance of physical activities and also to improve the quality of life.For this reason, the use of health-related quality of life measures in COPD has currently achieved widespread acceptance.It has been found that (66.2%) of COPD pa ents were males at the age group (50-59), (60-69) years and them Mean age was 58.80±10.02years.These findings were supported by (7) , who indicated that the mean (±SD) age of subjects was 58.3±11.0 years (range, 45-82 years).Out of 131 pa ents, (61%) were men.Regarding the marital status the results of present study indicated that (72.5%) of the sample were married.This result agrees with a study done by Aslani (7) who indicated that (88%) were married, (6%) were single, and (6%) were widows.The finding of the present study revealed that a high percentage (56.2%) of COPD patients had occupations before disease ,were self employee (working in shop work during exposure to chemical agent such as acid in batteries, others drive diesel car and others works with wool or cotton , metal workers ) while most of them (65.0%)unemployed a er disease.the researcher (8) reported that the occupations include coal miners, metal workers, grain handlers, cotton workers and workers in paper mills.other research (9) stated that the occupational factors are believed to contribute to the population burden of chronic obstructive pulmonary diseases.Regarding smoking behavior the results present the majority of study Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)sample(61.2%),were previously smoking and most of them (65%) were smoking cigare es and the majority(68.3) of COPD pa ents were smoking one pack and the majority of them( 36.7)smoked for 20-29 years and most of them (69.6%) were subjected to an exposure to passive smoking.In support of this study stated that there were 50 current smokers (19%),194 (73%) former smokers, 20 (8%) had never smoked (10) .other research (11) reported that the pa ents had a smoking history of >10 pack-years17also stated that 61% of the study sample showed that was ex-smokers.Blackler, et al. (8) who stated that the exposure to cigarette smoke also can contribute to respiratory symptoms and COPD.
According to Socio-demographic status, the results of present study showed that the incomes of most (43.8%) of the sample were not sufficient.In support of these result the research (7) reported that the study sample showed low incomes.The findings of the clinical characteristics of chronic obstructive pulmonary disease show that most of the sample (56.3%) were (1-2) years of dura on of diagnosis.The patients with COPD are more obsessive about their health during the first years of disease .This is expressed by the patients by visiting the clinics frequently (Researcher).The outcome of the study revealed that most of study samples (56.3) were admi ed to hospital (1-2) mes.In support of this result Almagro (12) men on that 75(58.5%)patients were readmitted.was associated with previous hospitalization for COPD in the past year.The results of present study show that most of the sample (56.0%) didn't have a family history of COPD.Alph 1-antirypsin deficiency (AAT deficiency) is a rare disorder and is the only known genetic (inherited) factor that increases the risk of developing COPD (13) .The findings of the present study revealed that the highest percentage (53.7%) of the sample their Body mass index was 25.0-29.9Kg/m2 (over weight).the researcher (14) reported that 77% had a body mass index (BMI) 25 kg/m2.According to Severity of disease the results show that the highest percentages (38.8%) were Moderate (FEV1/FVC less 70 %and FEV1 %less than 50 % -80%).The measurement of FEV1 is essen al for the diagnosis and quantification of the respiratory impairment resulting from COPD (15) .In addition, the rate of decline in FEV1 is a good marker of disease progression and mortality).However, FEV1 does not adequately reflect all the systemic manifestations of the disease.The research (14) reported that the last spirometric measurement of the mean FEV1 value was 55.1 -14.3%.The severity of disease was mild in 33.8% of cases, moderate in 49.3% and severe in16.8%. the research (16) stated that according to the GOLD guideline, most (72%) of the pa ents were in stage 2 (mean: FEV1 1.9 ± 0.75 L, 53.1% ± 18.5% predicted).the state (17) men oned that 10 of the study sample showed that had mild, 12 had moderate, and 5 had a severe disease .The results of the study show that the quality of life domains were three levels of effect: higher effect of disease on QOL was in physical domain, level of independence, and environmental domain.While, the effect is moderate in the psychological domain and social domains, low in the spiritual domain.In a study carried out by Chan-Yeung (18) , who reported that 90% of individuals in the COPD group thought that the physical capacity was the most important domain indicated that the symptom which has the most profound effect on their quality of life and other research stated that the physical activity allows normal functioning during daily life, both at home and at work.In healthy subjects, the regular physical activity improves health and prognosis.In patients, reduced physical activity is a marker of disease severity, often a poor prognostic marker, and always a key contributor to reduced health status (19) some research shows that things such as positive beliefs, comfort and strength gained from religion, meditation and prayer can contribute to healing and a sense of well-being.Improving your spiritual health may not cure an illness (20) .
The results of the present study show that there is significant difference between QOL domain and family history of COPD while other clinical variables such as the period of diagnosis, hospitalization, relatives who have COPD, body mass index, severity of disease have no significant difference with QOL for COPD patients.

Table 1 -
a. Distributions of COPD Patients according to socio-demographic variables

Table 1 -
b. Distribution of COPD patients related to smoking information (n=80)

Table 3 .
Distribution of the patient regarding to quality of life domains Min-Max= minimum-maximum, R.S=relative sufficiency No effect of disease on Quality of life less than 66.67, Low effect of disease on Quality of life 66.67-77.67,Moderate effect of disease on Quality of life 77.78-88.89,High effect of disease on Quality of life 89-100; R.S=Relative sufficiency;

Table 4 .
Distribution of the patient regarding to quality of life grads (poor and acceptable and good) by number and percentages

Table 5 .
Significant differences between total score of the QoL domains and Socio-demographic characteristics Total

score QOL with variable of the study
H.

Table 6 .
Significant differences between the total score of the QoL domains and smoking Total

score QOL with variable of the study
H.S=Highly significant; Min-Max= minimum-maximum; N.S=Not significant; P-value=Level of Probability; QOL=Quality of life, SD= Standard deviation; Sig=Significance

Table 7 .
Significant differences between the total score of the QoL domains and clinical characteristics Total

score QOL with variable of the study Mean±SD Min-Max P value Sig.
H.S=Highly significant; Min-Max= minimum-maximum; N.S=Not significant; P-