HEALTH RELATED QUALITY OF LIFE ASSESSMENT USING ST. GEORGE'S RESPIRATORY QUESTIONNAIRE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS ON COMBINED INHALED CORTICOSTEROIDS AND BRONCHODILATORS
Objective: Chronic diseases like COPD have significant effects on patient's health-related quality of life (HRQoL). HRQoL measures additional indices as compared to objective measurements like spirometry. Our aim is to assess and compare the disease-specific quality of life in Chronic Obstructive Pulmonary Disease patients using St. George's Respiratory Questionnaire (SGRQ-C) receiving Salmeterol/Fluticasone (SF), Formoterol/Budesonide (FB), Formoterol/Fluticasone (FF).
Methods: A prospective, open-label, randomized, parallel group study conducted at a tertiary care teaching hospital in South India. A 6-months follow-up of 90 patients with severe and very severe COPD randomized to receive Salmeterol/Fluticasone, Formoterol/Budesonide, and Formoterol/Fluticasone in appropriate doses according to their global initiative for chronic obstructive lung disease (GOLD) severity. After spirometry, St. George's Respiratory Questionnaire (SGRQ-C) was administered at baseline and after 180 d to assess improvement in lung function and HRQoL. Statistical analysis used: Data analyzed using SPSS version: 13.0. General linear repeated measures using the post-hoc Bonferroni method assessed significance between treatment groups.
Results: Significant decrease (P<0.05) in each SGRQ-C domains and total scores as well as improvement in FEV1 (P<0.05) was observed in all study subjects. The mean SGRQ-C total score for the group I subjects (SF) at the initial visit was 86.69 and the scores reduced to 58.78 at final visit (i.e. after using SF for 6 mo). This reduction was highly significant statistically (t=10.989, p=0.000) at 95% CI. The mean SGRQ-C total scores for group II subjects (FB) at initial visit were 85.85 and the scores reduced to 67.98 at the final visit. This reduction was highly significant statistically (t=9.669, p=0.000) at 95% CI. The mean SGRQ-C total scores for group III subjects (FF) at initial visit were 83.96 and the scores reduced to 70.37 at final visit (after 6 mo). This reduction was highly significant statistically (t=12.285, p=0.000) at 95% CI.
Conclusion: Maximum improvement in HRQoL (P<0.05) was noted in patients receiving Salmeterol/Fluticasone with respect to SGRQ-C (activity, impact and total) scores and FEV1. This improvement with SF was due to its greater effect in patients with severe and very severe chronic obstructive pulmonary disease. There was a significant improvement in QoL with SF as compared to FB and FF in severe and very severe COPD patients. Subsequently, the three combined inhaled corticosteroids and bronchodilators showed similar improvements in lung functions and Health related quality of life throughout the study.
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