OBJECTIVES: Health-related quality of life (HRQoL) is an important indicator of disease burden. To explore the impact of COPD on HRQoL, including the physical, mental, emotional, and societal impacts, a systematic literature review was conducted.

METHODS: Electronic databases (MEDLINE/in Process and Embase) and conference proceedings were searched in October 2016. Studies (non-interventional, published since 2000) that assessed HRQoL in patients with COPD who had moderate-severe disease and/or a history of exacerbations were included.

RESULTS: Overall, 74 studies were included in the review. Regardless of health status at the time of assessment (clinically stable or around the time of an exacerbation), or instrument used, HRQoL was significantly impaired in patients with COPD. Over half of the studies (N=43) evaluated the St. George’s Respiratory Questionnaire (SGRQ), an instrument used to measure the impact of COPD on symptoms, activity and psychosocial aspects of health (scale: 0-100; higher scores represent more impairment). Around the time of a hospitalised exacerbation, SGRQ total scores ranged from 45 in patients with moderate COPD (50%≤FEV<80% predicted) to 79 in those with very severe disease (FEV<30% predicted). Where evaluated, most studies found that HRQoL was significantly poorer in frequent than in infrequent exacerbators (as measured using the SGRQ [5/5 studies], COPD Assessment Test (CAT) [3/4], and the Short-Form (SF)-12/SF-36 [physical component score (PCS) [3/3], all p<0.05), and for patients with more severe (vs. less severe) airflow obstruction (SGRQ [6/8], SF-36 [PCS; 8/8], CAT [2/2], all p<0.05). Most long-term studies indicated that in COPD patients HRQoL declined progressively, with significant worsening in activity and symptoms. Other factors associated with impairment included symptom severity, comorbidities, and levels of physical activity.

CONCLUSIONS: This review highlights a considerable patient burden in COPD, especially for those with a history of exacerbations and/or more severe COPD. Further studies assessing longitudinal changes in HRQoL are required.