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Original Research: COPD |

Chronic Bronchitis Is Associated With Worse Symptoms and Quality of Life Than Chronic Airflow ObstructionWorse Symptoms in Chronic Bronchitis

Paula M. Meek, PhD, RN; Hans Petersen, MS; George R. Washko, MD; Alejandro A. Diaz, MD; Victor Kim, MD; Akshay Sood, MD, MPH, FCCP; Yohannes Tesfaigzi, PhD
Author and Funding Information

From the College of Nursing (Dr Meek), University of Colorado-Denver, Denver, CO; the COPD Research Program (Mr Petersen and Dr Tesfaigzi), Lovelace Respiratory Research Institute, Albuquerque, NM; Brigham and Women’s Hospital (Drs Washko and Diaz), Harvard Medical School, Boston MA; Temple University School of Medicine (Dr Kim), Philadelphia, PA; and the Department of Internal Medicine (Dr Sood), University of New Mexico, Albuquerque, NM.

CORRESPONDENCE TO: Yohannes Tesfaigzi, PhD, Lovelace Respiratory Research Institute, 9495 Ridgecrest Dr SE, Albuquerque, NM 87108; e-mail: ytesfaig@lrri.org


FUNDING/SUPPORT: This work was supported by funding from the State of New Mexico (appropriation from the Tobacco Settlement Fund) and from the National Institutes of Health [Grants RO1 ES015482 and HL68111 to Dr Tesfaigzi, K23HL094531, 8UL1TR000041 to Dr Sood, K23HL094696 to Dr Kim, and R01HL089856 and R01HL089897 COPDGene Funding].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(2):408-416. doi:10.1378/chest.14-2240
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BACKGROUND:  COPD includes the chronic bronchitis (CB) and emphysema phenotypes. Although it is generally assumed that emphysema or chronic airflow obstruction (CAO) is associated with worse quality of life (QOL) than is CB, this assumption has not been tested.

METHODS:  The current study’s analyses from the Lovelace Smokers’ Cohort (LSC) were validated in the COPD Gene Cohort (COPDGene). CB without CAO (CB only) was defined as self-reported cough productive of phlegm for ≥ 3 mo/y for 2 consecutive years and postbronchodilator FEV1/FVC ≥ 70%. CAO without CB (CAO only) was defined as a postbronchodilator FEV1/FVC < 70% with no evidence of CB. QOL outcomes were obtained from the St. George’s Respiratory Questionnaire (SGRQ) and the 36-Item Short Form Health Survey (SF-36) questionnaires. A priori covariates included age, sex, pack-years of smoking, current smoking, and FEV1.

RESULTS:  Smokers with CB without CAO (LSC = 341; COPDGene = 523) were younger and had a greater BMI and less smoking exposure than did those with CAO only (LSC = 302; COPDGene = 2,208). Compared with the latter group, QOL scores were worse for those with CB only. Despite similar SGRQ Activity and SF-36 Role Physical and Physical Functioning, SGRQ Symptoms and Impact scores and SF-36 emotional and social measures were worse in the CB-only group, in both cohorts. After adjustment for covariates, the CB-only group remained a significant predictor for “worse” symptoms and emotional and social measures.

CONCLUSIONS:  To our knowledge, this analysis is the first to suggest that among subjects with COPD, those with CB only present worse QOL symptoms and mental well-being than do those with CAO only.

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