Distinct symptom experiences in subgroups of patients with COPD

Vivi L Christensen; Tone Rustøen; Bruce A Cooper; Christine Miaskowski; Anne H Henriksen; Signe B Bentsen; Are M Holm

doi:10.2147/COPD.S105299

Distinct symptom experiences in subgroups of patients with COPD

Int J Chron Obstruct Pulmon Dis. 2016 Aug 2:11:1801-9. doi: 10.2147/COPD.S105299. eCollection 2016.

Authors

Vivi L Christensen¹, Tone Rustøen², Bruce A Cooper³, Christine Miaskowski⁴, Anne H Henriksen⁵, Signe B Bentsen⁶, Are M Holm⁷

Affiliations

¹ Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Ullevål; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Lovisenberg Diaconal University College.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway.
³ Department of Community Health Systems.
⁴ Department of Physiological Nursing, University of California, San Francisco, CA, USA.
⁵ Department of Circulation and Medical Imaging, St Olav's University Hospital, Trondheim.
⁶ Department of Health Studies, University of Stavanger, Stavanger.
⁷ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Abstract

Background: In addition to their respiratory symptoms, patients with COPD experience multiple, co-occurring symptoms.

Objectives: The aims of this study were to identify subgroups of COPD patients based on their distinct experiences with 14 symptoms and to determine how these subgroups differed in demographic and clinical characteristics and disease-specific quality of life.

Patients and methods: Patients with moderate, severe, and very severe COPD (n=267) completed a number of self-report questionnaires. Latent class analysis was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of self-reported symptoms using the Memorial Symptom Assessment Scale.

Results: Based on the probability of occurrence of a number of physical and psychological symptoms, three subgroups of patients (ie, latent classes) were identified and named "high", "intermediate", and "low". Across the three latent classes, the pairwise comparisons for the classification of airflow limitation in COPD were not significantly different, which suggests that measurements of respiratory function are not associated with COPD patients' symptom burden and their specific needs for symptom management. While patients in both the "high" and "intermediate" classes had high occurrence rates for respiratory symptoms, patients in the "high" class had the highest occurrence rates for psychological symptoms. Compared with the "intermediate" class, patients in the "high" class were younger, more likely to be women, had significantly more acute exacerbations in the past year, and reported significantly worse disease-specific quality of life scores.

Conclusion: These findings suggest that subgroups of COPD patients with distinct symptom experiences can be identified. Patients with a higher symptom burden warrant more detailed assessments and may have therapeutic needs that would not be identified using current classifications based only on respiratory function.

Keywords: COPD; latent class analysis; quality of life; symptom experience.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Age Factors
Aged
Cost of Illness*
Cross-Sectional Studies
Female
Humans
Lung / physiopathology*
Male
Middle Aged
Norway
Prognosis
Pulmonary Disease, Chronic Obstructive / complications
Pulmonary Disease, Chronic Obstructive / diagnosis*
Pulmonary Disease, Chronic Obstructive / physiopathology
Pulmonary Disease, Chronic Obstructive / psychology
Quality of Life
Risk Factors
Self Report
Severity of Illness Index
Sex Factors
Time Factors