Impact of COPD Phenotype on Disease Specific HR-QoL using CAT and SGRQ-C Score: A Hospital-based Observational Study

HEALTH-RELATED QUALITY OF LIFE AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT A TERTIARY HOSPITAL IN BANGLADESH

Comparison of Spirometric Parameters, Symptom Burden and Rehabilitation Implications in Current and Former Smokers with Chronic Obstructive Pulmonary Disease

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive, preventable, and treatable respiratory disease strongly associated with tobacco exposure. Because its clinical expression is heterogeneous, rehabilitation planning requires assessment beyond spirometry. Methods and materials: This retrospective observational study included 767 patients with COPD evaluated between October 2014 and January 2021 in the Pneumology Department of the "Victor Babes" Infectious Diseases Hospital, Timisoara, Romania. Patients were divided according to smoking status into current smokers (n=337) and former smokers (n=430). COPD diagnosis was based on specialist clinical assessment and spirometric evidence of airflow obstruction; post-bronchodilator FEV1/FVC (reported as BPI in the database) 0.70 was used as the reference criterion according to GOLD recommendations. Demographic data, body mass index, spirometric parameters, CAT, mMRC, exacerbations, and comorbidities were analysed. Results: The cohort included 593 men and 174 women, aged 37-92 years. Mean age was 63.5 ± 9.5 years and mean BMI was 28.6 ± 6.7 kg/m2. Mean forced vital capacity (FVC) was 2.78 ± 1.02 L, mean forced expiratory volume in one second (FEV1) was 1.69 ± 0.72 L, and mean FEV1% was 58.87 ± 20.57%. Current smokers had slightly higher mean FVC and FEV1 values than former smokers, without statistically significant spirometric differences. Former smokers reported higher CAT scores (24.8 ± 6.9 vs. 23.1 ± 7.0; p 0.001) and mMRC scores (2.79 ± 0.66 vs. 2.63 ± 0.67; p 0.001), indicating a greater symptom burden. Arterial hypertension was the most frequent comorbidity (n=514), followed by heart failure (n=147), diabetes mellitus (n=120), and pulmonary neoplasm (n=62). Exacerbations were present in 404 patients (53%). Conclusion: In this cohort, smoking status was associated with small spirometric differences, whereas former smokers reported greater symptom burden. Multidimensional assessment combining spirometry, CAT, mMRC, smoking exposure history, comorbidity screening, and individualized pulmonary rehabilitation is essential in COPD management.

Quality of Life and Symptom Burden Among Patients with Chronic Obstructive Pulmonary Disease in Pakistan

Background: Chronic obstructive pulmonary disease (COPD) is associated with airflow limitation, substantial symptom burden, functional restriction, psychological morbidity, and impaired health-related quality of life (HRQoL). Patient-reported measures may capture disease burden not fully reflected by spirometric severity. Objective: To assess HRQoL and symptom burden among patients with COPD in Pakistan and examine their relationships with airflow limitation, respiratory symptoms, and psychological characteristics. Methods: This cross-sectional study included 93 patients with COPD attending Johar Institute of Professional Studies from March to September 2025. Clinical variables included demographics, smoking and biomass exposure, COPD duration, FEV₁ percentage predicted, and GOLD stage. Symptom burden was assessed using the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scale, while HRQoL was evaluated using the St George’s Respiratory Questionnaire (SGRQ) and estimated EQ-5D index. Depression and anxiety were classified using PHQ-9- and GAD-7-based criteria. Data were analysed using SPSS version 26.0. Results: Mean age was 60.43±8.69 years; 69.9% were male. GOLD 2 disease was present in 68.8%, while 21.5% had GOLD 3–4 disease. Mean CAT and SGRQ scores were 25.19±9.97 and 59.41±15.34, respectively; 79.6% had CAT >10 and 80.6% had mMRC ≥2. CAT correlated strongly with SGRQ (ρ=0.869) and inversely with EQ-5D (ρ=−0.846), while FEV₁ showed weaker correlations. CAT, FEV₁, and probable depression remained independently associated with HRQoL. Conclusion: Pakistani patients with COPD experienced marked symptom burden and HRQoL impairment, supporting multidimensional assessment beyond spirometry alone. Keywords: COPD; quality of life; CAT; SGRQ; dyspnea; EQ-5D; Pakistan.

Questionnaire-Based Assessment of Physical Disability in COPD

Purpose Chronic Obstructive Pulmonary Disease (COPD) is characterized by a progressive limitation of exercise capacity and functional disability, induced by both airway obstruction, skeletal muscle dysfunction and comorbidities, contributing to the disease burden. The Health Assessment Questionnaire – Disability Index (HAQ-DI), a validated tool assessing functional disability in rheumatologic diseases, with higher scores reflecting more severe disability, may be of interest in COPD. This study aimed to assess functional disability in COPD using the HAQ-DI and its association with disease severity and burden. Patients and Methods Mild to very severe COPD patients were included in the RINNOPARI prospective cohort (NCT02924818). Pulmonary function tests and 6-minute walking test (6MWT) results, HRCT emphysema quantification, and patient-reported outcomes, including mMRC, CAT, SGRQ, EQ-5D and SF-36, were recorded. Functional disability was assessed using the French version of the HAQ-DI. Results A total of 117 patients were included, with a median HAQ-DI score of 0.38 [0.0–0.75]. HAQ-DI scores were significantly higher in COPD GOLD 3–4 (0.50 [0.13–0.75] vs 0.25 [0–0.63] in COPD GOLD 1–2, p = 0.015). HAQ-DI was associated with cardiovascular and depression comorbidities (p < 0.05), COPD clinical features (number of exacerbations, p = 0.015; mMRC dyspnea score, CAT score and 6MWT distance, all p < 0.001), and COPD burden as assessed by SF-36, SGRQ and HAD anxiety and depression scores, p < 0.001 for all. Multivariate analysis identified the 6MWT distance, CAT, SGRQ, and HAD-Depression scores as independent factors associated with HAQ-DI. We further identified a « High Functional Disability » (HFD) phenotype defined by HAQ-DI ≥ 1 (n = 20), and characterized by COPD poor prognosis markers and severe disease burden. Conclusion The HAQ-DI is a feasible tool for screening functional disability in COPD. It allowed the identification of a « high-risk, high burden » phenotype, which could benefit from personalised management such as pulmonary rehabilitation and psychological support.

Correlation between CT-determined emphysema and the severity of acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study

Background The high prevalence of chronic obstructive pulmonary disease (COPD) poses a significant social burden. Emphysema is a basic pathological change associated with poor lung function in stable COPD. However, few studies have focused on the potential role of emphysema in acute exacerbation of COPD (AECOPD). The current study aimed to explore the correlation between CT-determined emphysema and other main physiological parameters of severe AECOPD. Methods In total 90 hospitalized patients with AECOPD participated in this cross-sectional study. All of them underwent chest CT scans and lung function tests as planned. Emphysema was defined as the percentage of low attenuation areas (LAA) below −950 Hounsfield Units (%LAA−950) on inspiratory CT scans. Health-Related Quality of Life (HRQoL) was assessed using four questionnaires, including the St. George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council dyspnea scale, COPD Assessment Test, and EXAcerbation of Chronic Pulmonary Disease Tool (EXACT). Qualified data from 73 patients were included in the analysis. Results %LAA−950 was significantly correlated with spirometry parameters and HRQoL scores. The SGRQ and EXACT scores were significantly positively correlated with %LAA−950 (ρ = 0.399, p < 0.001; ρ = 0.370, p = 0.001, respectively). The ratio of the forced expiratory volume in the first 1 s to the forced vital capacity of the lungs and the percentage of predicted forced expiratory volume in first 1 s, which are functional indicators of airflow limitation, were significantly negatively correlated with %LAA−950 (ρ = −0.735, p < 0.00; ρ = −0.602, p < 0.001, respectively). Based on the stepwise multiple linear regression model showed that FEV1/FVC and age could be predictors of %LAA−950 (R2 = 0.592, F = 50.762, p < 0.001). Conclusion In patients with severe AECOPD, CT-determined emphysema is associated with decreased lung function and poor HRQoL. Trial registration The study was registered on the Chinese Clinical Trial Registry (registration number: ChiCTR2000033101).

Quality of Life in Pre-Dialysis Chronic Kidney Disease: Influence of Gender, Stage, Symptom Burden, and Comorbidities

Introduction. Chronic kidney disease (CKD) negatively affects health-related quality of life (HRQoL) even in the pre-dialysis stages. However, data regarding gender- and stage-related differences in Eastern European CKD populations remain sparse compared to major international cohorts like CRIC and DOPPS. In this study, Low quality of life (low QoL) was defined as a Physical Component Summary (PCS) score below the 25th percentile of the cohort distribution. Materials and Methods. This cross-sectional study included 989 adults with CKD stages I–V undergoing conservative management. HRQoL was evaluated using the KDQOL-36™ questionnaire. We performed gender and CKD stage comparisons, Pearson correlations, and multivariate logistic regression to identify predictors of low QoL. Symptom burden was assessed via structured patient interviews, complemented by the KDQOL-36™ symptom domain to ensure standardized reporting. Results. The mean patient age was 58.3 ± 12.5 years, and 52.8% were male. The mean PCS and Mental Component Summary (MCS) scores were 40.2 ± 10.8 and 43.5 ± 11.2, respectively. Women had lower PCS scores than men (38.0 vs. 41.0; p < 0.05) and a higher prevalence of fatigue (95.0% vs. 85.0%) and dysuria (70.8% vs. 52.6%; p < 0.001). QoL declined progressively with advancing CKD stage (PCS 44.2 in stages I–II vs. 34.5 in stages IV–V; p < 0.001), and PCS correlated positively with eGFR (r ≈ 0.45; p < 0.001). Independent predictors of low QoL included advanced CKD stage (OR 2.72), diabetes (OR 1.94), anemia (OR 1.80), hypoalbuminemia (OR 1.70), a disease duration of >5 years (OR 1.50), and female sex (OR 1.38). Conclusions. HRQoL is substantially impaired in pre-dialysis CKD, particularly among women and patients with advanced disease, highlighting the need for targeted, patient-centered interventions.