A prospective study to assess the quality of life in COPD patients: In a tertiary care centre

 Corresponding author: Blessy Ann Rajeev Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. A prospective study to assess the quality of life in COPD patients: In a tertiary care centre A.Abhi 1, Acsah Oommen 1, Blessy Ann Rajeev 1, *, Alfet Raju Anthraper 2, Chitra C Nair 3 and Beena P 4 1 Pharm D Intern, KVM College of Pharmacy, Cherthala, Kerala, India. 2 Associate Professor, Department of Pharmacy Practice, Cherthala, Kerala, India. 3 Professor and HOD, Department of Pharmacy Practice, Cherthala, Kerala, India. 4 Principal, KVM College of Pharmacy, Cherthala, Kerala, India. World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 Publication history: Received on 31 December 2024; revised on 11 February 2025; accepted on 14 February 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.21.2.0155 Abstract Background, aims and objectives: COPD is one of the leading cause of mortality and morbidity worldwide. It shows a decline in the lung function followed by impairment of physical functions. Quality of life is an important factor for measuring the impact of COPD in the patient from socializing and enjoying their hobbies.This study aimed at assessing the health related improvement in the quality of life of COPD patients. Materials and methods: A hospital-based prospective study was conducted in a tertiary care hospital, Kerala, India to assess the quality of life in 100 COPD patients for a period of 6 months by using St. George respiratory Questionnaire(SGRQ). Demographic details, therapy related factors and smoking status were collected. Result: In our analysis of 100 COPD patients, at the baseline assessment, the average SGRQ score was 59.92, with a standard deviation of 16.77. Conversely, during the follow-up period, there was a decrease in the mean score to 36.17, with a standard deviation of 14.23, indicating a decline in the SGRQ score over time. Lower SGRQ scores indicated better respiratory health and fewer symptoms. Conclusion: The results from our study revealed an improved quality of life among COPD patients significantly over time. The change in the mean SGRQ (St. George's Respiratory Questionnaire) score from 59.92 to 36.17 indicates an improvement in respiratory health or quality of life among the population being studied. When individuals adhere more closely to their medication regimens, they are more likely to manage their condition effectively, leading to better health outcomes and an enhanced quality of life. Keywords: COPD; SGRQ; Quality of life; Patients 1. Introduction Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible.1 The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. COPD is a general term that covers a variety of other disease including chronic bronchitis and emphysema2 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 330 1.1. Signs and symptoms Patients commonly exhibit a mix of signs and symptoms associated with chronic bronchitis, emphysema and reactive airway disease.2 1.1.1. The symptoms include • Cough is a prevalent symptom, typically more pronounced in the mornings, accompanied by the production of a small amount of colourless sputum. • Breathlessness is the most significant symptom, but it typically does not manifest until the sixth decade of life • Wheezing may manifest in certain patients, especially during exertion and exacerbations. 1.2. Quality of life • Quality of life (QOL) is an important domain for measuring the impact of chronic disease. Both general and diseasespecific instruments have been used to measure QOL in patients with COPD. 2 • Among the disease-specific questionnaires frequently used to evaluate the QOL of pulmonary patients is St. George’s Respiratory Questionnaire (SGRQ).3 A new version of the SGRQ, the SGRQ-C specific only to COPD, is now available. COPD impairs quality of life, by preventing people with the condition from socializing and enjoying their hobbies.1 It also makes many feel frustrated and angry about not being able to do the things they want to. • The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have outlined the treatment goals for patients with COPD.4 These encompass the patient’s aspirations for improved exercise tolerance and emotional well-being (health-related quality of life), along with crucial clinical goals such as preventing disease progression and minimizing symptoms.4 1.3. Aim To analyze the improvement in the quality of life among COPD patients. Objectives One of the main objective is to acess the quality of life in COPD patients. 2. Materials and methods The study was a prospective, conducted at a tertiary care hospital on 100 COPD patients for a period of six months. The inclusion criteria are patients with COPD in OPD, above 18 years of age. Patients with other co morbid conditions, polypharmacy, and patients of all gender were included in the study. Patients admitted with acute exacerbation of COPD or respiratory failure, patients who are bedridden and pregnant women were excluded. Quality of life (QoL) in COPD patients is significantly impacted by symptoms like breathlessness, fatigue, and reduced mobility, leading to social isolation and mental health issues. Key factors affecting QoL include disease severity, frequent exacerbations, physical limitations, and comorbidities. Improving QoL involves pulmonary rehabilitation, medication adherence, smoking cessation, oxygen therapy (if needed), nutritional support, and psychological care. Tools like the St. George’s Respiratory Questionnaire (SGRQ) help assess QoL. Effective management can enhance daily functioning and well-being in COPD patients. The data were entered into Microsoft Excel Spreadsheet and Statistical analysis was performed by IBM SPSS 22.0. After obtaining permission from the IEC, study began with data collection. Case records were retrospectively and prospectively reviewed for demographic data, clinical presentations, investigations, management and prognosis. 3. Results and discussion Table 1 Frequency and percentage distribution of sample according to age in years (N=100) Age (in years) Frequency Percentage (%) 30-40 1 1 41-50 7 7 51-60 15 15 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 331 61-70 39 39 71-80 27 27 >80 11 11 Figure 1 Age wise distribution of the study population Inference The study reveals that COPD predominantly affects older individuals, with the highest prevalence observed in the 61–70-year age group Table 2 Frequency and percentage distribution of samples according to gender Gender Frequency (n=100) Percentage (%) Male 52 52 Female 48 48 Figure 2 Gender distribution INFERENCE The data shows that COPD is more common in men, with 52% of patients being male. This suggests that men are at a higher risk for COPD when compared to womens Table 3 Frequency and percentage distribution of sample according to smoking history [N=100] Patients Frequency(n=100) Percentage (%) Non-smokers 77 77 Ex-smokers 13 13 Smokers 10 10 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 332 Figure 3 Prevalence of COPD among smokers, ex-smoker and non-smokers Inference: The data highlights that the majority of COPD patients are non-smokers (77%), with all 48 females and 29 males falling into this category Table 4 Frequency and percentage distribution of sample according to symptom on admission [N=100] Symptom on admission Frequency(n=205) Percentage (%) Shortness of breath 91 44.39 Cough 62 30.24 Sputum 19 9.26 Fever 12 5.85 Wheezing 8 3.90 Chest pain 4 1.95 Body pain 3 1.46 Headache 2 0.97 Sputum with blood 2 0.97 Throat pain 1 0.48 Low appetite 1 0.48 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 333 Figure 4 Bar graph representing symptom on admission of the study population Our study reveals that the most common symptom on admission among COPD patients are shortness of breath, cough, sputum production and fever. These symptoms are indicative of respiratory distress and infection. Conversely, less prevalent symptoms include wheezing, chest pain, body pain, headache, blood with sputum, throat pain and low appetite. Understanding these symptom patterns is crucial for timely diagnosis and appropriate management of COPD, ensuring that patients receive the necessary care tailored to their specific symptoms and needs Table 5 Frequency and percentage distribution of sample according to allergy [N=100] Allergy Frequency(n=100) Percentage(%) Present 62 62 Absent 38 38 Figure 4 Distribution of sample according to allergy World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 334 INFERENCE: The chart indicates that COPD patients show a higher susceptibility to allergies. This finding underscores the importance of considering allergic factors in the management and treatment of COPD patients, as allergic reactions could potentially exacerbate respiratory symptoms and contribute to disease progression. Table 6 Frequency and percentage distribution of sample according to types of allergies [N=62] Types of allergies Frequency(n=73) Percentage (%) Dust 59 80.82 Smoke 6 8.21 Chalk powder 4 5.47 Pungent smell 2 2.73 Cold 1 1.36 Milk 1 1.36 Figure 5 The prevalence among COPD patients to different type of allergies INFERENCE: Our study highlights the substantial impact of allergens, particularly dust and smoke, on COPD patients. These allergens significantly affect the majority of individuals in our study Table 7 Frequency and percentage distribution of sample according to comorbidity of patients [n=100] Comorbidity of patients Frequency(n=143) Percentage (%) Hypertension 47 32.86 Diabetes mellitus 37 25.87 Dyslipidaemia 20 13.98 Coronary artery disease 17 11.88 Hypothyroidism 7 4.89 Chronic kidney disease 3 2.09 Tuberculosis 2 1.39 Benign prostate hyperplasia 2 1.39 Transient ischemic attack 1 0.699 Non-hodgkin’s lymphoma 1 0.699 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 335 Parkinson’s disease 1 0.699 Addison’s disease 1 0.699 Tachycardia 1 0.699 Migraine 1 0.699 Stroke 1 0.699 Fatty liver 1 0.699 Figure 6 The distribution of sample according to comorbidities of patient INFERENCE: Our study highlights hypertension (32.86%), diabetes mellitus (25.87%), and dyslipidemia (13.98%) as prevalent comorbidities among COPD patients, potentially impacting their quality of life. These conditions can exacerbate respiratory symptoms, worsen disease progression and increase the risk of complications. Addressing these comorbidities alongside COPD management is crucial for improving patient outcomes and enhancing overall quality of life Table 8 Frequency and percentage distribution of sample according to occupational exposure [n=100] Occupational exposure Frequency(n=100) Percentage (%) Present 80 80 Absent 20 20 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 336 Figure 7 The distribution of sample according to occupational exposure INFERENCE: The chart illustrates that a majority of patients in our study, specifically 80 out of 100, have occupational exposure. Table 9 mean, standard deviation, mean difference, t value and p value of sgrq score during baseline and follow-up [N=100] Time Mean Standard deviation Mean difference t value (paired t test) p value Baseline 59.92 16.77 23.75 14.568 <0.001*** Follow-up 36.17 14.23 *** Significant at 0.001 level Figure 8 The mean, standard deviation, mean difference, t value and p value of MMAS score during baseline and follow-up In the baseline assessment, the mean value of the SQRQ score was 59.92, indicating a relatively higher level of symptom severity, quality of life impairment, and patient perception of control over their respiratory condition. However, during the follow-up period, after intervention the mean value decreased significantly to 36.17. This reduction suggests an improvement in symptom severity, quality of life, and perceived control over the respiratory condition among COPD patients. These findings highlight the effectiveness of interventions and treatment strategies in alleviating symptoms and enhancing the overall well-being of individuals with COPD. World Journal of Biology Pharmacy and Health Sciences, 2025, 21(02), 329-338 337 4. Conclusion The results from our study revealed improved quality of life among COPD patients. The change in the mean SGRQ (St. George's Respiratory Questionnaire) score from 59.92 to 36.17 indicates an improvement in respiratory health or quality of life among the population being studied. When individuals adhere more closely to their medication regimens, they are more likely to manage their condition effectively, leading to better health outcomes and an enhanced quality of life. Therefore, in this study, an improved health-related quality of life was observed in COPD patients. Compliance with ethical standards Acknowledgments We take this opportunity to express our deep sense of gratitude and respectful regards to Dr. Subin E B MBBS MD, Pulmonologist, SH Medical Centre, Kottayam for their immense support, encouragement and credible ideas which have been great contributors in completion of this thesis. We are also thankful to the Management, Nursing Staff and all other Staffs of SH Medical Centre, Kottayam, for their immense support. We sincerely express our gratitude and respect to Mr. Manu K Joseph who helped us a lot in the statistics section. Disclosure of conflict of interest No conflict of interest to be disclosed Statement of ethical approval The study was approved by the Institutional Ethics Committee. Statement of informed consent Informed consent was obtained from all individual participants included in the study. References [1] Zamzam M A et al., Quality of life in COPD patients. 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