Beyond the lungs: The role of extrapulmonary manifestations in the quality of life of Indians with chronic airway diseases

Purpose: Chronic airway diseases (CAD) including chronic obstructive pulmonary disease (COPD), persistent asthma (>= 2weekly episodes) and bronchiectasis, exhibit overlapping extrapulmonary manifestations potentially affecting health-related quality-of-life (HRQOL). The study objective was to quantify HRQOL of CAD patients and identify impact of associated pulmonary and extrapulmonary manifestations. Methodology: Total 101 established CAD patients were recruited cross-sectionally (COPD, n = 61, persistent asthma, n = 30 and bronchiectasis, n = 10). Patients completed spirometry, body composition (Dual-energy Xray Absorptiometry), muscle function (isometric and isokinetic dynamometry), exercise capacity (6-min walking distance, 6MWD) and patient reported outcomes, including physical activity, sleep and hospital anxiety and depression scale. HRQOL was assessed using EuroQol quality-of-life questionnaire and utility score (EQ-5D index) was stratified into tertiles to compare patient characteristics. Result: Mean age of participants was 60.9 +/- 12.8y, and 25.7% were female. Mean EQ-5D index was 0.658 (95% CI: 0.596, 0.721), significantly lower than population norms and other chronic diseases including diabetes, cardiovascular diseases and rheumatoid heart disease (p < 0.01). Participants in lowest EQ-5D tertile were older, had higher depression, lower 6MWD, lower handgrip and quadriceps muscle strength than other two tertiles, whereas anxiety was higher in both lowest and intermediate tertile compared to highest tertile (p < 0.01). In the adjusted regression model, age (AOR:1.187) depression (AOR:1.438), anxiety (AOR:1.266), and body fat (AOR:1.114) showed increased odds for poor EQ-5D index while in intermediate vs highest EQ-5D tertile, only age (AOR: 1.125) and anxiety (AOR:1.403) showed a significant association. Conclusion: HRQOL is significantly lower in CAD compared to other chronic non-communicable diseases and significantly associated with extrapulmonary manifestations. Interventions targeting modifiable risk factors may aid in improving HRQOL in CAD.