The impact of treatment of pulmonary exacerbations on the health-related quality of life of patients with cystic fibrosis: Does hospitalization make a difference?

Michael S. Yi, Joel Tsevat, Robert W. Wilmott, Uma R. Kotagal, Maria T. Britto

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

Objectives To investigate the impact of pulmonary exacerbations on the health-related quality of life (HRQOL) of patients with cystic fibrosis (CF) and to elucidate factors that are associated with changes in HRQOL post-exacerbation. Study design Participants completed questionnaires at a pre-exacerbation visit, at the beginning of the exacerbation, and at the post-exacerbation visit. To measure HRQOL, we used the Child Health Questionnaire-Parent Form (PF-50) and the Medical Outcomes Study Short Form-36 (SF-36). We examined demographic, clinical, and treatment-related predictor variables for association with change in Physical Summary (PhS) and Psychosocial Summary (PsS) HRQOL scores after an exacerbation. Results We collected data from 48 subjects. Patients experiencing exacerbations who were treated as outpatients had a mean (SD) age of 19.5 (12.7) years and a mean pre-exacerbation forced expiratory volume in 1 second (FEV1) of 70% (36%) of predicted; 53% were female. Patients treated as inpatients had a mean age of 14.6 (5.5) years and a mean FEV1 of 56% (24%); 56% were female. In univariate analyses, exacerbations were associated with a statistically significant decrease in FEV1 (-10.0%) and PhS scores (-4.5 points). PsS scores did not significantly change with exacerbations (-0.7 points). In multivariable analyses examining change between pre-exacerbation and post-exacerbation visits, no variables were significantly associated with change in PhS scores. However, not being hospitalized for the exacerbation was associated with deterioration in PsS scores, and being hospitalized was associated with improvement in PsS scores (β coefficient: 9.4; P < .01) by the post-exacerbation visit. Results were similar from the exacerbation to the post-exacerbation visit. Conclusion In patients with CF, on average, pulmonary exacerbations affect physical HRQOL more than psychosocial HRQOL. Being hospitalized for exacerbations is associated with improvement in psychosocial HRQOL after exacerbations, whereas not being hospitalized is associated with deterioration.

Original languageEnglish (US)
Pages (from-to)711-718
Number of pages8
JournalJournal of Pediatrics
Volume144
Issue number6
DOIs
StatePublished - Jun 1 2004

Keywords

  • CF
  • Child Health Questionnaire-Parent Form
  • Cystic fibrosis
  • FEV
  • Forced expiratory volume in 1 second
  • HRQOL
  • Health-related quality of life
  • IV
  • Intravenous
  • MCID
  • Minimal clinically important difference
  • PF-50
  • PhS
  • Physical Summary
  • PsS

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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