Evaluation of health outcomes in elderly patients with asthma and COPD using disease-specific and generic instruments - The Salute Respiratoria nell'Anziano (Sa.RA) Study

Objectives: To compare the effects of asthma and COPD on health status (HS) in elderly patients, and to assess the correlation between disease-specifi c and generic instruments assessing HS. Design: Multicenter, cross-sectional, observational study. Setting: The Salute Respiratoria nell'Anziano (respiratory health in the el derly) Study network of outpatient departments. Patients: One hundred ninety-eight asthma patients and 230 COPD patients gr eater than or equal to 65 years old. Measurements: HS was assessed by the Saint George's Respiratory Questionnai re (SGRQ) and five generic outcomes: Barthel's index, 6-min walk test, mini mental state examination, geriatric depression scale (GDS), and quality-of -sleep index. Independent correlates of SGRQ scores were assessed by logist ic regression. Patients were considered to have a "good" HS or "poor" HS ac cording to whether they did or did not perform worse than 75% of the corres ponding population of asthma or COPD patients, on at least two of the five generic outcomes. Results: On average, COPD patients had poorer HS than asthma patients on th e SGRQ. Only polypharmacy (more than three respiratory drugs) and diagnosis of COPD qualified as independent correlates of the SGRQ score. The SGRQ "A ctivity" and "Impacts" scores shared the following independent correlates: polypharmacy, Barthel's index < 92, and GDS > 6. Further correlates were wa ist/hip ratio > 1 for the Activity score, and age and occiput-wall distance > 9 cm for the Impacts score. All sections of the SGRQ except for the Symp toms score could significantly distinguish patients with good HS and poor H S. Conclusions: Individual dimensions of HS recognize different determinants. COPD outweighs asthma as a cause of distressing respiratory symptoms. A hig h degree of concordance exists between SGRQ and generic health outcomes, ex cept for the Symptoms dimension in COPD patients.