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Construct Overview of Chronic Obstructive Pulmonary Disease (COPD)/Shortness of Breath

Please note that this section is an archive and is no longer being updated.

Most Frequently Cited Instruments
Instrument Summaries
  1. Chronic Respiratory Questionnaire (CRQ)
  2. St. George's Respiratory Questionnaire (SGRQ)
  3. Asthma Quality of Life Questionnaire (AQLQ)

Source: Major Scientific Journal Publications [Jan 2006]
Additional Resources
Website Evalautions

External Links

Background

Shortness of breath, also known as dyspnea, is a perception of breathing difficulty or of not getting enough air. It is a common symptom of several respiratory and cardiovascular diseases, including asthma and COPD. Asthma is an inflammatory disease that causes episodes of airflow obstruction, coughing, chest tightness, and wheezing. Exacerbations of asthma are at least partially reversible with treatment, if not spontaneously remitting.1

Chronic obstructive pulmonary disease (COPD) is a general term for several irreversible conditions that result in airflow limitation and breathing difficulties, including emphysema and chronic bronchitis.2 Unlike asthma, which is often asymptomatic between attacks, COPD is a progressive disease that is associated with multisystemic complications such as sleep disturbance, fatigue, and muscle wasting.3-4 COPD is associated with significant morbidity and mortality and is currently the fourth leading cause of death in the United States.2,5

VA Relevance

Whereas asthma is diagnosed among 2.5% of the VA user population, COPD is one of the most common chronic conditions diagnosed among VA health care users, affecting approximately 9.4% of this population.6 COPD is the fourth most common diagnosis among veterans discharged from VA hospitals, accounting for approximately 16% of all inpatient admissions.7

Veterans and active military personnel are at increased risk for tobacco use and nicotine addiction, a major risk factor in the development of COPD.7 Military service during the 1990-1991 Gulf War has been also described as a potential risk factor for respiratory symptoms.8 However, the etiology and course of service-related symptoms have not been well defined.9-11

Measurement

Techniques such as spirometry and various forms of exercise testing are often used in the assessment of respiratory disease.12 Although such "objective" tests provide physiological indices of disease progression, they may not accurately reflect the patient's subjective health state. Because treatment for chronic respiratory diseases (especially COPD) is primarily symptom-focused, it is important to incorporate the patient's self-report into health assessment.4,13

Both generic and disease-specific measures have been used to assess self-reported health status and well being among persons with respiratory diseases.4 Typically, disease-specific instruments assess the presence or frequency of respiratory symptoms as well as the impact of the disease on the respondent's quality of life. Disease-specific instruments may be more responsive than generic instruments to treatment-induced changes in health status; thus, they may be more sensitive outcome measures for the purposes of clinical trials.14 On the other hand, generic instruments may be used to compare health status in respiratory disease with that of other clinical populations or the general population.

The meaning of within-patient or within-treatment group change scores on a given measure is subject to interpretation. Some efforts have been made toward identifying a score threshold or a magnitude of change in scores that signifies a "clinically important" improvement in health status. However, implicit in designating such a threshold is the assumption that it applies equally well to all respondents. Methods of assessing clinically important change are variable and not widely agreed upon. A key problem is defining the criterion by which clinically importance change will be defined - clinician perception, patient perception, or other criteria may be used.15,16

Through literature review, METRIC identified three commonly used instruments for measuring health-related quality of life in chronic respiratory disease. These are ranked according to number of citations, as determined by the ISI Web of Knowledge.17 What follows is a brief summary

of each instrument and three applicable references.

Most Frequently Cited Instruments

[ISI Web of Knowledge, accessed Jan 2006]

  1. Chronic Respiratory Questionnaire (CRQ)
    [535 Citations]
  2. St. George's Respiratory Questionnaire (SGRQ)
    [455 Citations]
  3. Asthma Quality of Life Questionnaire (AQLQ)
    [336 Citations]
References
  1. Bousquet J, Jeffery PK, Busse WW, Johnson M, Vignola AM. Asthma: from bronchoconstriction to airways inflammation and remodeling. Am J Resp Crit Care Med 2000;161:1720-1745. [Abstract]
  2. National Heart, Lung, and Blood Institute, National Institutes of Health. Chronic obstructive pulmonary disease: data fact sheet. Accessed January 2006. Available: http://www.nhlbi.nih.gov/health/public/lung/other/copd_fact.pdf.
  3. Decramer M, De Benedetto F, Del Ponte A, Marinari S. Systemic effects of COPD. Resp Med Suppl 2005;99:S3-S10. [Abstract]
  4. Jones PW. Health status measurement in chronic obstructive pulmonary disease. Thorax 2001;56:880-887. [Abstract]
  5. Chronic obstructive pulmonary disease surveillance-United States, 1971-2000. MMWR August 2, 2002;51(SS06);1-16. Accessed January 2006. Available: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5106a1.htm.
  6. Yu W, Ravelo A, Wagner TH, Phibbs CS, Bhandari A, Chen S, Barnett PG. Prevalence and costs of chronic conditions in the VA health care system. Med Care Res Rev Suppl 2003;60:146S-167S. [Abstract]
  7. Roman J, Perez RL. COPD in VA hospitals. Clin Cornerstone 2003;5:37-44. [Abstract]
  8. Iowa Persian Gulf Study Group. Self-reported illness and health status among Gulf War veterans: a population-based study. JAMA 1997;277:238-245. [Abstract]
  9. Fiedler N, Giardino N, Natelson B, Ottenweller JE, Weisel C, Lioy P, Lehrer P, Ohman-Strickland P, Kelly-McNeil K, Kipen H. Responses to controlled diesel vapor exposure among chemically sensitive Gulf War veterans. Psychosom Med 2004;66:588-598. [Abstract]
  10. Karlinsky JB, Blanchard M, Alpern R, Eisen SA, Kang H, Murphy FM, Reda DJ. Late prevalence of respiratory symptoms and pulmonary function abnormalities in Gulf War I veterans. Arch Intern Med 2004;164:2488-2491. [Abstract]
  11. Lange JL, Schwartz DA, Doebbeling BN, Heller JM, Thorne PS. Exposures to the Kuwait oil fires and their association with asthma and bronchitis among gulf war veterans. Environ Health Perspect 2002;110:1141-1146. [Abstract]
  12. O'Donnell DE, Lam M, Webb KA. Measurement of symptoms, lung hyperinflation, and endurance during exercise in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;158:1557-1565. [Abstract]
  13. van der Molen T, Kocks JWH. Do health-status measures play a role in improving treatment in chronic obstructive pulmonary disease? Expert Opin Pharmacother 2006;7:57-61. [Abstract]
  14. Guyatt GH, King DR, Feeny DH, Stubbing D, Goldstein RS. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol 1999;52:187-192. [Abstract]
  15. Hajiro T, Nishimura K. Minimal clinically significant difference in health status: the thorny path of health status measures? Eur Respir J 2002;19:390-391. [Abstract]
  16. Jones PW. Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J 2002;19:398-404. [Abstract]
  17. ISI Web of Knowledge. Accessed January 2006. Available: http://isi01.isiknowledge.com/portal.cgi/wos/.


[created 24 Mar 2006]