INTRODUCTION:
Chronic
obstructive pulmonary disease (COPD) is recently the most common chronic lung
disease and presents a serious medical, economic, and social problem for
people. Globally, COPD affects around 210 million people1. It is a
fourth-leading cause of death among diseases.
The
World Health Organization (WHO) predicts that by 2030, the disease will reach
third place (WHO, 2007)2. According to WHO2, in the year
2016, the prevalence of COPD is 251 million globally. It was estimated that, 3.17 million deaths were caused by
this disease, in 2015, more than 90% of COPD deaths occur in low- and
middle-income countries. There were 28.1 million cases of COPD in India in 1990, this increased
to 55.3 million in 2016, showed a September 2018 study published in The
Lancet Global Health. India has 18% of the world’s population but 32% of
its COPD burden3.COPD is responsible for nearly a million deaths
every year, as India Spend reported in March 20193. Better
treatment, psychological and social support system minimize the damages and
complications, lessens exacerbations of COPD clients’ and need for
hospitalization. COPD affects Health Related Quality of Life (HRQOL) which,
deteriorates and worsen prognosis. The psychological co-morbidity is frequently
unrecognized and is often ignored. For chronic disease management, including
chronic obstructive pulmonary disease (COPD), client’s quality of life plays an
important role.4
Major
cause of morbidity in the elderly population is chronic obstructive pulmonary
disease (COPD). Chronic obstructive pulmonary disease severity is defined by
the Global Initiative of Chronic Obstructive Lung Disease staging criteria.
Those are GOLD-1, 2, 3 & 4. COPD leads to a reduced quality of life (QQL),
but the contributing factor are not well understood. A better understanding of
the factors will determine improved care for such patients leading to a better
HRQOL.5
There
is paucity of published literature regarding factors affecting the quality of
life (QOL) of COPD patients in India. So, the present study was aimed to assess
the QOL of COPD patients and to determine the relationship between QOL and
disease severity.
Methods and patients:
Correlational
survey research design was intended to describe the correlation between the
quality of life and disease severity among (COPD) clients attending a pulmonary
Medicine OPD of a tertiary care hospital in Kolkata. Through purposive sampling
technique 138 adults (18 - 60 years age) COPD patients recruited. Severity of
COPD is assessed through standard GOLD criteria6 that are as
follows:
·
GOLD 1 – mild: FEV1≥ 80% predicted
·
GOLD 2 – moderate: 50% ≤FEV1
<80% predicted
·
GOLD 3 – severe: 30% ≤FEV1
<50% predicted
·
GOLD 4 – very severe: FEV1 <30% predicted.
Standardized
WHO QOL BREF7 tool was used to assess Quality of Life. The internal
consistency (Cronbach’s α) coefficients ranged from 0.70 to 0.77 for the
four domains. Reliability of the demographic data collection tool was
established by inter- rater method. Pretesting of the tools was done to check
the clarity, feasibility, practicability and ambiguity of language. Ethical
clearance was taken from institutional Ethics Committee. Informed consent was
taken before data collection. The statistical analyses were carried out in SPSS
version19.
RESULTS:
Table 1: Frequency and percentage distribution of
Socio- demographic characteristics of COPD clients. N= 138
|
Socio-demographic characteristics
|
Frequency
|
Percentage
|
|
Age
18- 30 years
31-40 years
41-50 years
51 -60 years
|
13
42
58
25
|
9.42
30.43
42.03
18.12
|
|
Gender Male
Female
|
76
62
|
55.07
44.93
|
|
Marital status
Married Unmarried
|
125
13
|
90.58
9.42
|
|
Religion
Hindu Muslim
|
36
102
|
26.09
73.91
|
|
Education Graduate
H.S.
Primary Illiterate
|
3
19
94
22
|
2.17
13.77
68.12
15.94
|
|
Occupation Student
House wife Labor Service
Self employee
|
2
29
94
11
2
|
1.45
21.01
68.12
7.97
1.45
|
|
Residence
Rural Urban
|
80
58
|
57.97
42.03
|
|
Duration of suffering
<1 year
1-5 year
>5 year
|
113
25
0
|
81.88
18.12
0
|
|
Addiction
Smoking bidi
Smoking cigarette Non smoking
|
18
2
118
|
13.04
1.45
85.51
|
|
Income
5000 RS./Month
5000-10000 RS./Month
|
135
3
|
97.83
2.17
|
Figure-1: Pie diagram showing disease severity of COPD
clients according to Global Initiative for Chronic Obstructive Lung Disease
(GOLD) criteria.
59%
clients attending at chest medicine OPD diagnosed with COPD are from rural
area, 86% stated that they have never smoked, where as 12% population has
stated that they smoke bidi and 2% smoke cigarette. Figure-1 revealed that
maximum (59%) of the COPD clients suffer from moderate severity and (40%) of
COPD clients suffer from mild severity and (1%) suffer from severe disease
according to score of GOLD criteria of COPD.
Table-2
depicts that QOL in social domain (58%) is ranked as 1st, Physical
domain (52%) is ranked as 2nd, environmental domain (48%) is ranked
3rd and psychological domain (46%) is ranked 4th. Table-3, 4, 5
& 6 depict that most of the COPD patients have moderate QOL in physical,
psychological and environmental domain and most (90.57%) of them have high QOL
in social domain only. Table-7 depicts that there is no correlation between
disease severity and COPD clients’ total QOL, QOL of physical domain,
psychological domain, social domain and environmental domain. Table-8 shows
that there is no significant association found between quality of life and
demographic variables.
DISCUSSION:
The
findings of the present study revealed that most of the COPD patients have
moderate QOL in physical, psychological and environmental domain and most
(90.57%) of them have high QOL in social domain only. Whereas many other
studies8-10 revealed that QOL in COPD patients was significantly
poor. Such variation may be because of the different instrument (St. George’s
respiratory questionnaire vs. WHOQOL) used for assessing QOL and some studies
have only assessed HRQOL and some assessed total QOL.
This
study also found that there is no co-relation between QOL with disease severity
of COPD patients but Agrawal et al11 have reported a strong
association between increased severities of COPD with poor QOL in a correlation
study of COPD severity with HRQL. In another study, Uppal et al12
also found inverse correlation between all the stages of disease severity and
QOL in COPD patients.
Socio-demographic
variables such as age, sex, education, occupation etc. are not found to have
significant effect on quality of life in COPD patients in the present study.
Gaude NC et al13 study also showed the same results whereas some
have reported worsening of SGRQ scores with increasing age.9,14-15
Some
studies have reported that females have poor QOL as compared to males.15-16
However, some have reported no correlation between sex and QOL.9
Some study13 has reported poor QOL in patients with poor socioeconomic
status
while in Ahmed M et al study9 showed socioeconomic status was not
found to be significantly associated with impaired QOL. This may be due to the
distribution of study participants in the present study because maximum study
participants are from the rural area and most of them are from very poor
socioeconomic class and no participant are from higher economic class.
This
study has limitation too. Firstly, small sample size. Secondly, spirometry was
not done at the time of the study to assess the severity of the disease. We
also didn’t study other co-morbidities which might have an impact on QOL.
CONCLUSION:
The
present study found that majority of COPD clients had moderate disease severity
and their total QOL was moderate. There is no correlation between disease
severity and QOL. So it is evident that the quality of life among COPD clients
who attended a tertiary care hospital does not depend on disease severity.
Further research needs to be done to assess the impact of social and family support
to improve the QOL.
REFERENCES:
1.
Kendrova L, Mikulakova W, Nachvatal
P, Homzova P, Gajdos M, Cuj J. Quality of life in patients with chronic
obstructive pulmonary disease in Slovakia. Hrvatska revija za rehabilitacijska
istrazivanja. 2015 Dec 28; 51(2): 57-63.
2.
https://www.who.int/news-room/fact-sheets/detail/chronic- obstructive-pulmonary- disease-(copd).
3.
Why India Is Struggling To Tackle
Its Lung Disease Crisis By Swagata Yadavar Last Updated: July 21st, 2019. IndiaSpend,
Governance newsletter. Accessed on 27thMay 2021 from https://www.indiaspend.com/why-india-is-struggling-to-tackle-its- pulmonary-disease-crisis/
4.
Jennings KM. The Roy adaptation
model: a theoretical framework for nurses providing care to individuals with
anorexia nervosa. ANS. Advances in nursing science. 2017 Oct; 40(4): 370.
5.
Cheruvu VK, Odhiambo LA, Mowls
DS, Zullo MD, Gudina AT. Health-related quality of life in current smokers with
COPD: factors associated with current smoking and new insights into sex
differences. International journal of chronic obstructive pulmonary disease.
2016; 11: 2211.
6.
Global strategy for the diagnosis,
management, and prevention of chronic obstructive pulmonary disease, Global
initiative for chronic obstructive pulmonary disease (GOLD). Available from
<http://www.goldcopd.org>, 2010.
7.
World Health Organization.
WHOQOL-BREF: introduction, administration, scoring and generic version of the
assessment: field trial version, December 1996. Geneva: World Health
Organization; 1996.
8.
Jain A, M Richpal & Jain G.
Study of Predictors of Quality of Life and its Association with Anxiety and Depression
in Chronic Obstructive Pulmonary Disease in Industrial Worker. Indian Community
Med, 2020; 45(3): 338-342.
9.
Ahmed M, Neyaz A, Aslami A.
health-related quality of life of chronic obstructive pulmonary disease
patients: Results from a community based cross-sectional study in Aligarh,
Uttar Pradesh, India. Lung India. 2016; 33:
148-53.
10.
Halvani A, Pourfarokh N, Nasiriani
K. Quality of life and related factors in patients with chronic obstructive
pulmonary disease. Tanaffos. 2006; 5(3): 51–6
11.
Agrawal SR, Joshi R, Jain A.
Correlation of severity of chronic obstructive pulmonary disease with
health-related quality of life and
six-minute walk test in a rural hospital of central India. Lung India. 2015;
32: 233–40.
12.
Uppal M, Gupta B, Suri JC, Mittal
V. Factors affecting severity, functional parameters, and quality of life in
COPD patients. JIACM. 2014; 15: 42–6.
13.
Gaude N.C, Dessai A M. Health
related quality of life in COPD patients: a cross-sectional study. Int J Community
Med Public Health. 2018 May; 5(5): 2038-2042
14.
Shavro SA, Ezhilarasu P, Augustine
J, Bechtel JJ, Christopher DJ. Correlation of health-related quality of life
with other disease severity indices in Indian chronic obstructive pulmonary
disease patients. Int J Chron Obstruct Pulmon Dis. 2012; 7: 291–6.
15.
Gobartt E, Lucas P De, Group S.
Health-related quality of life in outpatients with COPD in daily practice: the
VICE Spanish study. Int J Chron Obstruct Pulmon Dis. 2008; 3(4): 683–92.
16.
Wijnhoven H a, Kriegsman DM,
Hesselink AE, Penninx BW, de Haan M. Determinants of different dimensions of
disease severity in asthma and COPD : pulmonary function and health-related
quality of life. Chest. 2001; 119(4): 1034–42.
Received on 27.05.2021 Modified
on 02.07.2021
Accepted on 30.07.2021 ©A&V Publications All right reserved
Asian J. Nursing
Education and Research. 2021; 11(4):528-532.
DOI:
10.52711/2349-2996.2021.00125
