To Örebro University

Background: Risk factors for poor health related quality of life (HRQL), mortality and exacerbations in Chronic Obstructive Pulmonary Disease (COPD) need to be explored.

Objectives: To examine associations of comorbidity and Body Mass Index (BMI) with HRQL using the Clinical COPD Questionnaire (CCQ); to examine the prognostic qualities of the multidimensional instrument DOSE index; to examine the association of health status estimated by the CCQ with mortality; and to examine management of exacerbations and subsequent exacerbation risk.

Material: Randomly selected patients from primary and secondary care, usingthe COPD cohort of the PRAXIS study. Information was collected using apatient questionnaire, record review and a clinical questionnaire. Mortalitydata wereobtained from the National Board of Health and Welfare.

Methods: Multiple linear regression analysis, survival analysis and standardisedmortality ratios.

Results: Heart disease, depression and underweight were associated withhigher CCQ. A higher DOSE index was associated with higher mortality. Ahigher CCQ was associated with higher mortality risk and mortality risk wasraised compared with the general population. Exacerbation management inprimary care was not optimal. An extra scheduled visit to an asthma/COPDnurse was associated with a reduced risk of subsequent exacerbations.

Conclusions: The influence of comorbidity on HRQL in COPD patients is important. The DOSE index is useful as it combines important issues in COPD management with prognostic qualities. Health status estimated by CCQ is predictive of mortality. Exacerbation management in primary care COPD patients needs to be optimised, and nurse led asthma/COPD clinics may be a way to optimise resources with possible beneficial effects on exacerbation risk. These results could be used to improve COPD care and to facilitate focusing resources for those at greatest risk.