Prediction of COPD-specific health-related quality of life in primary care COPD patients: a prospective cohort study

Health-related quality of life (HRQL) is an important patient-reported outcome for chronic obstructive pulmonary disease (COPD). We developed models predicting chronic respiratory questionnaire (CRQ) dyspnoea, fatigue, emotional function, mastery and overall HRQL at 6 and 24 months using predictors easily available in primary care. We used the “least absolute shrinkage and selection operator” (lasso) method to build the models and assessed their predictive performance. Results were displayed using nomograms. For each domain-specific CRQ outcome, the corresponding score at baseline was the best predictor. Depending on the domain, these predictions could be improved by adding one to six other predictors, such as the other domain-specific CRQ scores, health status and depression score. To predict overall HRQL, fatigue and dyspnoea scores were the best predictors. Predicted and observed values were on average the same, indicating good calibration. Explained variance ranged from 0.23 to 0.58, indicating good discrimination. To predict COPD-specific HRQL in primary care COPD patients, previous HRQL was the best predictor in our models. Asking patients explicitly about dyspnoea, fatigue, depression and how they cope with COPD provides additional important information about future HRQL whereas FEV1 or other commonly used predictors add little to the prediction of HRQL. Previous health-related quality of life (HRQL) is the best predictor of future HRQL in patients with chronic obstructive pulmonary disease. Gerben ter Riet and colleagues at the University of Amsterdam, with collaborators at the University of Zurich, recruited 409 primary care patients from Switzerland and the Netherlands into a prospective cohort study. Patients were assessed on entry to the study and again by HRQL questionnaire after 6 and 24 months. The results indicated that asking patients explicitly about dyspnea, fatigue, depression and how they are coping with the disease can provide GPs with additional important information about future HRQL. Fatigue and dyspnea scores were the best predictors. Other commonly used predictors such as Forced Expiratory Volume in one second (FEV1) and exercise capacity add little to the prediction of HRQL.

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