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Observational Study
. 2025 Jul 11;9(1):88.
doi: 10.1186/s41687-025-00923-z.

Health status, respiratory symptom and dyspnea trajectories in subjects with chronic obstructive pulmonary disease: a seven-year observation in clinical practice

Koichi Nishimura  1   2 , Masaaki Kusunose  3 , Ayumi Shibayama  4 , Kazuhito Nakayasu  5
Affiliations
Observational Study

Health status, respiratory symptom and dyspnea trajectories in subjects with chronic obstructive pulmonary disease: a seven-year observation in clinical practice

Koichi Nishimura et al. J Patient Rep Outcomes. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation, often associated with declining health status. It is widely believed that the burden of the disease increases over time, leading to continuous suffering in the patient. Understanding the long-term course of patient-reported outcomes (PROs) and the variability in disease progression is crucial for effective management. The purpose of this research was to investigate the long-term trajectories of health status, respiratory symptoms, and dyspnea in COPD patients over a seven-year period and to identify factors associated with different progression patterns.

Methodology: This longitudinal study followed 70 COPD patients for seven years, with evaluations every six months. Participants underwent pulmonary function tests and completed four PRO measures: St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), Evaluating Respiratory Symptoms in COPD (E-RS), and Dyspnoea-12 (D-12). Annual changes were estimated using linear mixed models and linear regression analysis. The patients were categorized into quartiles based on the rate of decline in forced expiratory volume in one second (FEV1) and changes in PROs.

Results: The group showed a significant deterioration in the FEV1 and PRO measures. FEV1 declined by 25 milliliters annually, while SGRQ Total and CAT scores worsened by 1.4 and 0.6 units per year, respectively. However, substantial variability was observed between individuals. The SGRQ Total score worsened significantly after 1.0 year in the 4th quartile, while the 1st quartile showed improvements at 2.0, 2.5, 3.0, 4.0, 6.0 and 6.5 years. Similarly, while the CAT, E-RS Total and D-12 Total scores deteriorated in the fourth quartile, they remained stable or improved in the first quartile.

Conclusions: The progression of COPD varies widely among individuals. Although some patients experience significant declines, others remain stable or even improve for seven years. These findings challenge the belief that COPD inevitably leads to a constant increase in the burden of disease.

Keywords: Chronic obstructive pulmonary disease; Dyspnea; Health status; Patient-reported outcome measures; Quality of life.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The present study was approved by the Institutional Ethics Committee of the National Center for Geriatrics and Gerontology (No. 1138–3) (updated on 12 July 2020). Written informed consent was obtained from all patients before the study. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Changes in measured values over seven years, as calculated using a linear mixed model. The estimated mean and its 95% confidence interval of each indicator by a linear mixed model for each measurement point every 6 months during a 7-year period. A: forced expiratory volume in 1 s (FEV1) (Liters), B: St. George’s Respiratory Questionnaire (SGRQ) Total score, C: COPD Assessment Test (CAT) score, D: Evaluating Respiratory Symptoms in COPD (E-RS) Total score, E: Dyspnoea-12 (D-12) Total score. ***: p < 0.001, **: p < 0.01, *: p < 0.05 in comparison with baseline
Fig. 2
Fig. 2
Frequency distribution of annual rates of change determined by linear regression analysis of individual cases. A: forced expiratory volume in 1 s (FEV1) (Liters), B: St. George’s Respiratory Questionnaire (SGRQ) Total score, C: COPD Assessment Test (CAT) score, D: Evaluating Respiratory Symptoms in COPD (E-RS) Total score, E: Dyspnoea-12 (D-12) Total score
Fig. 3
Fig. 3
Comparison of the 1st, 2nd and 3rd, and 4th quartiles divided by annual change. The estimated mean and its 95% confidence interval of each indicator by a linear mixed model in the 1st, 2nd and 3rd, and 4th quartiles divided by annual rates of change using linear regression analysis of individual cases for each measurement point every 6 months during a 7-year period. A: forced expiratory volume in 1 s (FEV1) (Liters), B: St. George’s Respiratory Questionnaire (SGRQ) Total score, C: COPD Assessment Test (CAT) score, D: Evaluating Respiratory Symptoms in COPD (E-RS) Total score, E: Dyspnoea-12 (D-12) Total score. ***: p < 0.001, **: p < 0.01, *: p < 0.05 in comparison with baseline. Red line depicts 1st quartile, green shows 2nd and 3rd quartiles and blue indicates 4th quartile
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