Quality of life in asthma and COPD: is it measurable in primary care?

Background. An observational cross-sectional study under the acronym CORDIS (Chronic Obstructive Respiratory Disease - Italian Study), performed in primary care centers to evaluate the knowledge and the degree of control of physician-diagnosed asthma and chronic obstructive pulmonary disease (COPD) by Italian General Practitioners (GPs). The study consisted of two phases, CORDIS-A and CORDIS-B. The CORDIS-B study included measurement of the quality of life (QoL) of physician-diagnosed asthma and COPD patients. Aim. Aim of the study was to evaluate the applicability of QoL assessment by means of the SF-12 Questionnaire in primary care in subjects with asthma or COPD. Secondary, to evaluate the impact of the two respiratory diseases on patients’ QoL and to measure the correlation between patients’ and GPs’ opinion on patients’ health status. Methods. Patients enrolled in the study were males and females aged more than 18 years, with a physician (GP or specialist) diagnosis of asthma and/or COPD and treated from at least 12 months with a short-term inhaled β2-agonist, given alone or as component of a multiple therapy. Patients gave written informed consent to participate to the study and for personal data use. Each patient enrolled in the study privately filled in the QoL SF-12 questionnaire; both the patient and the GP gave independently the judgement of patient’s health (Excellent, Very good, Good, Acceptable, Poor) and the two opinions were compared. Results. Complete QoL data were available for 11,642 subjects with a mean age of 57 ± 17 years and a prevalence of males of 55.3%. The percentage of patients with asthma, COPD, and asthma plus COPD was 47.2%, 29.2% and 23.6%, respectively. At least one concomitant disease was present in 67% of patients. In terms of evaluation of patient’s health status, a perfect concordance between the two types of evaluators was found in 54.6%; the percentage increased up to 95% when considering just one category of difference between the GP’s and the patient’s evaluation. As for the general Italian population, no substantial gender difference was found in our study for the SF-12 “Physical Component Summary” (PCS) and “Mental Component Summary” (MCS) mean scores. However, the CORDIS-B subjects showed more impaired health status in comparison to general population. Asthmatic patients showed better PCS and MCS scores in comparison to patients with COPD or asthma plus COPD (p < 0.0001). Conclusions. This study shows that a) the SF-12 Questionnaire is a simple and useful tool to measure the QoL of patients with asthma and COPD in primary care; b) there was a very good agreement in the subjective evaluation of the patient’s health status between GP and patient; c) mental/psychological component is underestimated both by GP and patient