Respiratory Symptoms, Disease Burden, and Quality of Life in Australian Adults According to GOLD Spirometry Grades: Data from the BOLD Australia Study

Abstract

Purpose

Population data on the burden of chronic obstructive pulmonary disease (COPD) are often based on patient-reported diagnoses of COPD, emphysema or chronic bronchitis, without spirometry. We aimed to investigate the relationship between health burden, quality of life and severity of airway obstruction in Australian adults aged ≥40 years.

Methods

We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites to reflect the sociodemographic and geographic diversity of the Australian population (n = 3522). Participants with post-bronchodilator airflow limitation (ratio of forced expiratory volume in 1 second FEV₁ to forced vital capacity <0.7) were grouped by GOLD spirometry grades 1–4. Quality of life was assessed with Short Form 12 (SF-12) Health Survey Questionnaire. Health burden was assessed as lost time off work or social activities, and healthcare utilization.

Results

Of the study sample, 2969 participants did not have airflow limitation, 294 (8.4%) were classified as GOLD Grade 1, 212 (6.0%) as GOLD 2 and 43 (1.2%) as GOLD 3–4. Participants with higher GOLD grades had more respiratory symptoms, more comorbidities and greater burden than those with lower GOLD grades. The scores of mental and physical subscales of SF-12 were lower, indicating worse quality of life, from the no airflow limitation group to the GOLD 3–4 group (P = 0.03 and P < 0.001, respectively).

Conclusion

Greater airflow limitation is associated with greater burden and poor quality of life. Interventions to prevent, or reduce the level of, airflow limitation will reduce the symptom burden and improve quality of life for patients.

Keywords:

• chronic obstructive pulmonary disease
• airflow limitation
• comorbidities
• The Burden of Obstructive Lung Disease
• quality of life

Data Sharing Statement

The data that support the findings of this study are available at reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Human/Animal Ethics Approval Declaration

The BOLD Australia Study was approved by the Human Research Ethics Committee of the University of Sydney (ref. no. 12-2006/9724) and complies with the Declaration of Helsinki. Each study site also obtained local HREC approval, including approval from the Western Australian Aboriginal Health Information and Ethics Committee. Informed participant consent was obtained as per site-specific ethics approvals.

Acknowledgments

The BOLD study in Australia was funded by the National Health & Medical Research Council, Project Grant 457385. The BOLD study in Sydney was funded by grants from Air Liquide P/L, AstraZeneca P/L, Boehringer Ingelheim P/L, GlaxoSmithKline Australia P/L and Pfizer Australia P/L.

Operations Centre: Mrs Tessa E. Bird and Dr Wei Xuan (Woolcock Institute of Medical Research). Sydney: Professor Christine R. Jenkins, Mrs Tessa E. Bird, Dr Kate Hardaker and Dr Paola Espinel (Woolcock Institute of Medical Research).

Busselton: the late Professor A. W. (Bill) Musk, Dr Michael L. Hunter, Ms Elspeth Inglis and Ms Peta Grayson (University of Western Australia). Kimberley: Professor David N. Atkinson, Mr Dave Reeve, Dr Nathania Cooksley, Dr Matthew Yap, Ms Mary Lane, Dr Wendy Cavilla and Ms Sally Young (University of Western Australia). Melbourne: Ms Angela Lewis, Ms Joan Raven, Ms Joan Green and Ms Marsha Ivey (Monash University). Tasmania: Professor E. Haydn Walters, Mrs Carol Phillips and Ms Loren Taylor (University of Tasmania). NSW Rural: Dr Phillipa J. Southwell, Dr Bruce J. Graham, Dr Brian Spurrell, Mrs Robyn Paton, Ms Melanie Heine, Ms Cassandra Eccleston and Dr Julie Cooke (Charles Sturt University).

Disclosure

MJA holds investigator initiated grants from Pfizer, Boehringer-Ingelheim, Sanofi and GSK. He has conducted an unrelated consultancy for Sanofi. He has also received a speaker’s fee from GSK. MJA and RWB report cohort grants from the National Health & Medical Research Council. GBM has received funding for advisory boards with AstraZeneca. HKR holds investigator initiated grants from AstraZeneca, GlaxoSmithKline, Novartis, Perpetual Philanthropy. She has received consulting fees from AstraZeneca and GlaxoSmithKline and honoraria from AstraZeneca, GlaxoSmithKline, TEVA, Boehringer-Ingelheim, Sanofi, Getz, Chiesi and Alkem. HKR holds leadership roles in the Global Initiative for Asthma (GINA) and National Asthma Council (NAC). All other authors declare no competing interests in this work.