Dyspnoea and symptom burden in mild-moderate COPD: the Canadian Cohort Obstructive Lung Disease Study

Mathew Cherian; Dennis Jensen; Wan C Tan; Sara Mursleen; Emma C Goodall; Gilbert A Nadeau; Amnah M Awan; Darcy D Marciniuk; Brandie L Walker; Shawn D Aaron; Denis E O'Donnell; Kenneth R Chapman; François Maltais; Paul Hernandez; Don D Sin; Andrea Benedetti; Jean Bourbeau

doi:10.1183/23120541.00960-2020

Dyspnoea and symptom burden in mild-moderate COPD: the Canadian Cohort Obstructive Lung Disease Study

ERJ Open Res. 2021 Apr 19;7(2):00960-2020. doi: 10.1183/23120541.00960-2020. eCollection 2021 Apr.

Authors

Mathew Cherian¹, Dennis Jensen^{2

3

4}, Wan C Tan⁵, Sara Mursleen⁶, Emma C Goodall⁶, Gilbert A Nadeau⁶, Amnah M Awan⁶, Darcy D Marciniuk⁷, Brandie L Walker⁸, Shawn D Aaron⁹, Denis E O'Donnell¹⁰, Kenneth R Chapman¹¹, François Maltais¹², Paul Hernandez¹³, Don D Sin⁵, Andrea Benedetti^{14

15}, Jean Bourbeau^{1

3}

Affiliations

¹ Division of Respiratory Medicine, Dept of Medicine, McGill University Health Centre, Montreal, QC, Canada.
² Clinical Exercise and Respiratory Physiology Laboratory, Dept of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada.
³ Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada.
⁴ Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, QC, Canada.
⁵ Centre for Heart Lung Innovation, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁶ GSK, Mississauga, ON, Canada.
⁷ Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada.
⁸ Division of Respirology, Dept of Medicine, University of Calgary, Calgary, AB, Canada.
⁹ The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹⁰ Dept of Medicine/Physiology, Queens University, Kingston, ON, Canada.
¹¹ Asthma and Airway Centre, University Health Network and University of Toronto, Toronto, ON, Canada.
¹² Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada.
¹³ Faculty of Medicine, Division of Respirology, Dalhousie University, Halifax, NS, Canada.
¹⁴ Depts of Medicine and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
¹⁵ Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, QC, Canada.

Abstract

Studies assessing dyspnoea and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) have focussed on patients in clinical settings, not the general population. The aim of this analysis was to compare the prevalence and severity of dyspnoea and impaired HRQoL in individuals with and without COPD from the general population, focussing on mild-moderate COPD. Analysis of the 3-year Canadian Cohort Obstructive Lung Disease (CanCOLD) study included four subgroups: mild COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1); moderate COPD (GOLD 2); non-COPD smokers; and non-COPD never-smokers. The primary outcome was dyspnoea (Medical Research Council (MRC) scale), and the secondary outcome was HRQoL (COPD Assessment Test (CAT) score; Saint George's Respiratory Questionnaire (SGRQ) score). Subgroups were analysed by sex, physician-diagnosed COPD status and exacerbations. 1443 participants (mild COPD (n=397); moderate COPD (n=262(; smokers (n=449) and never-smokers (n=335)) were studied. People with mild COPD were more likely to report more severe dyspnoea (MRC 2 versus 1) than those without COPD (OR (95% CI) 1.42 (1.05-1.91)), and non-COPD never-smokers (OR (95%CI) 1.64 (1.07-2.52)). Among people with mild COPD, more severe dyspnoea was reported in women versus men (MRC2 versus 1; OR (95% CI) 3.70 (2.23-6.14)); people with, versus without, physician-diagnosed COPD (MRC2 versus 1; OR (95% CI) 3.27 (1.71-6.23)), and people with versus without recent exacerbations (MRC2 versus 1; ≥2 versus 0 exacerbations: OR (95% CI) 3.62 (1.02-12.86); MRC ≥3 versus 1; 1 versus 0 exacerbation: OR (95% CI): 9.24 (2.01-42.42)). Similar between-group differences were obtained for CAT and SGRQ scores. Careful assessment of dyspnoea and HRQoL could help identify individuals for earlier diagnosis and treatment.