Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease

Purpose How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in wellbeing may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD). Methods In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4 weeks, and 130 at 4 months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George's Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and wellbeing (World Health Organization-5 Well-being Index). Multiple regression analyses were performed. Results At 4 weeks and 4 months, changes in disease-specific QOL (st. β = -0.35, p < 0.001, partial (p) R² = 11-12 %), depression (st. β = -0.32 to -0.36, p < 0.001, pR² = 9-12 %), and anxiety (st. β = -0.21 to -0.40, p < 0.02-0.001, pR² = 4-15 %) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4 months (st. β = 0.21, p = 0.02, pR² = 4 %), but not with changes in depression. Conclusions Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Wellbeing may capture some aspects of mental QOL in COPD patients better than depression and anxiety.