Associations of Psychological and Respiratory Symptoms With Clinical Outcomes Among Patient with Chronic Obstructive Pulmonary Disease

Abstract

Abstract Rationale: Chronic obstructive pulmonary disease (COPD) is a common and treatable condition often associated with comorbidities that can exacerbate respiratory symptoms, reduce adherence to therapies, and increase hospitalization rates. This study aimed to 1) assess the prevalence of adherence to inhaler use and of psychological and respiratory symptoms among patients with COPD in Saudi Arabia, and 2) investigate whether the increased severity of such symptoms is associated with poor adherence to inhalers, diminished quality of life, higher rates of hospital and intensive care unit (ICU) admissions, and increased number of comorbidities. Methods: The 10-item Test of Adherence to Inhalers Scale was used to evaluate the level of adherence to inhaled medication. Quality of life was assessed using the St. George's Respiratory Questionnaire. COPD symptoms were assessed using the modified Medical Research Council Dyspnea Scale. The Hospital Anxiety and Depression Scale was used to assess symptoms of anxiety and depression. Clinical data (e.g., hospitalization and comorbidities) were collected from patients’ medical records. Univariate and multivariate regression models were used to assess the associations of psychological and respiratory symptoms with clinical outcomes. Results: A total of 214 patients with a confirmed diagnosis of COPD met our inclusion criteria and were included in the final analysis. Of these patients, 91 (42%) and 39 (18%) patients had at least one hospital and ICU admission in the last year, respectively. In addition, our results revealed that 113 (52.8%) patients did not adhere to the prescribed use of maintenance inhalers, 147 (68.6%) had impaired quality of life, and 110 (51.4%) had increased levels of breathlessness. In addition, 54 (25.2%) and 40 (18.6%) patients exhibited symptoms of anxiety and depression, respectively. Increased levels of anxiety and depressive symptoms were associated with poor adherence to inhalers, worsening quality of life, higher rates of hospital/ICU admission, increased number of comorbidities as well as higher number of prescribed COPD and non-COPD medications (Table 1). An increased level of COPD symptoms was also found to be correlated with worse clinical outcomes (Table 1). Conclusion: Our findings demonstrate a high prevalence of poor adherence to inhalers and psychological and respiratory symptoms among patients with COPD. More importantly, this increase in symptoms is associated with a diminished quality of life, poor adherence to inhalers, and higher rates of hospital and ICU admissions. These results suggest that early screening and detection of particularly worsening psychological symptoms may improve clinical outcomes in patients with COPD.