Physical Activity, Depression and Quality of Life in COPD – Results from the CLARA II Study

Abstract

Background

Symptoms of depression, pain and limitations in physical activity may affect quality of life in COPD patients independent from their respiratory burden. We aimed to analyze the associations of these factors in outpatients with COPD in Austria in a stable phase of disease.

Methods

We conducted a national, cross-sectional study among patients with COPD. For depression, the Patient Health Questionnaire-9 (PHQ-9) and for respiratory symptoms the St. George’s Respiratory Questionnaire for COPD patients (SGRQ-C) were used along with 10-point scales for physical activity and pain.

Results

After exclusion of 211 patients due to non-obstructive spirometry or missing data, 630 patients (62.5% men; mean age 66.8 ± 8.6 (SD) years; mean FEV₁%pred. 54.3 ± 16.5 (SD)) were analyzed. Of these, 47% reported one or more exacerbations in the previous year, 10.4% with hospitalization. A negative depression score was found in 54% and a score suggesting severe depression (PHQ-9 score ≥ 15) in 4.7%. In a multivariate linear regression model, self-reported pain, dyspnea, and number of exacerbations were predictors for higher PHQ-9-scores. A negative pain score was found in 43.8%, and a score suggesting severe pain in 2.9% (8–10 points of 10-point scale). Patients reporting severe pain were more often female, had more exacerbations, and reported more respiratory and depressive symptoms, a lower quality of life, and less physical activity. About 46% of patients rated their physical activity as severely impaired. These patients were significantly older, had more exacerbations, concomitant heart disease, a higher pain and depression score, and a lower quality of life (SGRQ-C – total score and all subscores).

Conclusions

In Austria, nearly half of stable COPD outpatients reported symptoms of depression, which were associated with lower levels of self-reported physical activity, more pain, and respiratory symptoms. The associations were particularly strong for depression with SGRQ-C.

Keywords:

• chronic obstructive pulmonary disease
• depression
• PHQ-9
• pain
• quality of life
• St. George’s Respiratory Questionnaire
• physical activity

Abbreviations

BMI, body mass index; CRF, case report form; COPD, chronic obstructive pulmonary disease; LAMA, long-acting muscarinic antagonist; LABA, long-acting β2-agonist; ICS, inhaled corticosteroid; PHQ-9, Patient Health Questionnaire-9; QoL, quality of life; SGRQ, St. George’s Respiratory Questionnaire; SGRQ-C, St. George’s Respiratory Questionnaire for COPD patients.

Ethics Approval and Consent to Participate

All participants provided written informed consent to participate in the study. The protocol was approved by the independent ethics committee of the Johannes Kepler University, Linz (vote 1129/2021). This study was conducted in accordance with the Declaration of Helsinki.

Acknowledgments

The authors wish to express their gratitude to all investigators who contributed to the conduct of the Clara II study. Funding was provided by A. Menarini Pharma GmbH. Statistical and writing assistance (initial draft “Background” and “Methods” sections) were provided by Datamedrix GmbH, Mag. Bernhard Kaiser and CW Research & Management GmbH (Dr. Wolfram Adlassnig).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr Horst Olschewski reports personal fees and/or non-financial support from Astra Zeneca, Boehringer, Menarini; personal fees from Chiesi, GSK and Novartis, outside the submitted work. Dr Sylvia Hartl reports grants and/or personal fees from GSK, Astra Zeneca, Menarini Pharma, Chiesi Farma, Roche Pharma, and MSD, outside the submitted work. Professor Arschang Valipour reports personal fees from Astra Zeneca, Boehringer Ingelheim, Chiesi, GSK, and Menarini, during the conduct of the study. Dr Georg-Christian Funk reports honorary for advisory board from Menarini Pharma. Dr Monika Merkle reports personal fees from Astra Zeneca, Boehringer Ingelheim, Chiesi, Menarini, Sanofi, and Novartis, outside the submitted work. Mrs Eva Wallner and Dr Stephan Brecht are employees of A. Menarini Pharma GmbH. The authors report no other conflicts of interest in this work.

Additional information

Funding

Funding of this study was provided by A. Menarini Pharma GmbH. The funding source had no role in data analysis, interpretation of the data, or decision to submit results.