Introduction

Chronic obstructive pulmonary disease (COPD) is the most common noncommunicable respiratory disease diagnosed in the 21st century and remains a global therapeutic and diagnostic problem, in particular among the elderly population [1]. As per the World Health Organization (WHO), over 250 million people worldwide are currently affected by this condition. In Poland, researchers suppose that the total number of COPD patients has probably reached around 2 million, but this figure is only an estimate, as no studies have been conducted on the general population to determine a definitive prevalence rate. It is also important to note that in Poland, around 9 million people are heavy smokers, and at least another 9 million Poles are passive smokers, which significantly contributes to the development of COPD [2].

The main risk factors for COPD development include active and passive smoking, occupational exposure, air pollution, recurrent bacterial or viral respiratory infections, asthma, and genetic predisposition. However, exposure to the aforementioned risk factors does not necessarily lead to the development of the disease. It has also been proven that unfavorable working conditions have a negative effect, as exemplified by people who have been exposed to chemicals and dust in the workplace over many years. Another mechanism involved in the development of chronic airflow obstruction through the airways is the decline in normal lung function that occurs with age. Patients with COPD are most often diagnosed with multiple diseases, the most common comorbidities being cardiovascular conditions and neoplastic diseases [3].

In clinical practice, early diagnosis of COPD remains a challenge for the entire therapeutic team. This is due to the asymptomatic nature of the disease in its early stages. In early development stages, COPD is most often diagnosed incidentally, e.g., during screening by a GP (Primary Healthcare Practitioner). This means that patients may go ill for many years without receiving any drug therapy, thus worsening their prognosis upon eventual diagnosis. A full symptomatic patient with diagnosed COPD does not always respond positively to treatment. Proper and effective control of the disease depends not only on the effectiveness of regularly administered medications, but also on how the method of administration and on the motivation of patients to change their health-related habits and to follow medical recommendations. Unfortunately, most patients with COPD experience chronic shortness of breath even when taking medication [4].

The treatment of COPD is based on alleviating the symptoms of this disease, improving bronchial patency, and reducing the incidence of symptom aggravations. When starting treatment, attention should be paid to the severity of perceived shortness of breath and the emergence of symptoms that reduce QoL, the incidence of symptom aggravations, and the degree of bronchial patency limitations. Due to the chronic nature of the illness, treatment should be impletemed continuously and should not be interrupted despite potential improvement in the patient’s health. Improved bronchial patency, reduced perceived shortness of breath, and a decrease in the frequency of symptom aggravations can be achieved by using bronchodilators, inhaled glucocorticosteroids, phosphodiesterase 4 inhibitors, antioxidants, mucolytics, benzodiazepines, and opioids [5].

COPD prevention involves patients having to give up smoking, which slows down the progression of the disease in people who are already ill.

Flu vaccinations and avoiding environments with high concentrations of dust and gases are also recommended [6]. Chronic oxygen therapy is used for people experiencing shortness of breath and chronic respiratory failure, due to its ability to prolong life expectancy and its beneficial effect on the QoL and the mental and physical condition of patients.

It is assumed that COPD affects men more often than women, but recently there have been changes in the gender proportions in the patient population. COPD, as a chronic disease, can significantly worsen patients’ QoL, which should be considered as a multidimensional and interdisciplinary construct. Patients with advanced COPD often experience physical debilitation, depressed mood, sleep disturbances, and severe chronic respiratory failure, which significantly reduce their QoL [7].

Aim of the study

The aim of the study is to assess the quality of life, as well as health-related and psychosocial problems of patients suffering from COPD.

Materials and method

The participant sample consisted of 280 people, including 74 (26.43%) women and 206 (73.57%) men treated in the Pulmonology, Allergology, and Internal Medicine Ward at the 4th Military Clinical Hospital with Polyclinic in Wrocław. The study was conducted in the period from August 2023 to February 2024. The inclusion criteria for the study were: COPD diagnosis, age over 60, intellectual capacity to complete the questionnaire independently, and informed consent granted to participate in the study. The study was approved by the Bioethics Committee no. KB – 30/2024 and was carried out in accordance with the Declaration of Helsinki.

The study used a self-developed questionnaire containing questions about age, gender, place of residence, marital status, education, QoL assessment, smoking habits, shortness of breath and coughing, spirometry testing administration, and comorbidities, as well as three standardized questionnaires:

Statistical analysis

Quantitative variables were analyzed by calculating the mean, standard deviation, median, and quartiles. Qualitative variables were analyzed by calculating the point and percentage of frequency of each value.

Results

A majority of the people participating in the study were aged between 60 and 65 (N=143; 51.07%), were mainly men (N=206; 73.57%), living in urban areas (N=235; 83.92%), married (N=173; 61.78%), with secondary education (N=109; 38.92%) and living with their families (N=176; 62.85%). Socio-demographic data are presented in Table 1.

Most of the respondents (N=157; 56.07%) rated their quality of life as good, 38.57% as average, and 5.36% as poor. Among the respondents, 73.57% (N=206) had smoked cigarettes during their lifetime, most often for over 20 years (N=147; 52.50%) or over 10 years (N=104; 37.14%). Patients mostly often consumed at least 20 cigarettes a day (N=180; 64.29%), which caused coughing (N=168; 60.00%) and shortness of breath (N=168; 60.00%). A more detailed breakdown of the symptom incidence is shown in Table 2.

All respondents underwent spirometry testing. A majority was found to suffer from comorbid conditions (N=196; 70.00%), the most common of which was hypertension (N=182; 65.00%), followed by diabetes (N=80; 28.57%), thyroid disease (N=24; 8.57%), asthma (N=21; 7.50%), post-stroke recovery period (N=14; 5.00%), post-myocardial infarction (N=7; 2.50%) and other, less frequently diagnosed conditions (N=14; 5.00%).

The analyses included the results gathered with the use of the CAT questionnaire, which assesses the severity of COPD symptoms and their impact on the patient’s daily life. The higher the score on the questionnaire, the higher the symptom severity. The results confirmed that the largest group of patients experienced moderate (N=130; 46.42%) or severe (N=105; 37.50%) symptoms of the disease (Table 3).

The respondents were also assessed in terms of their ability to live independently using the IADL scale, which permits the assessment of the patient’s ability to perform complex activities of daily living. The results confirmed that the respondents showed average independence in daily living activities (Table 4).

The analyses also included results from the PSQI questionnaire, which assessed the quality of sleep of the respondents. The results showed that most of them experienced moderate sleep disturbances (N=133; 47.50%), which may have been caused by nighttime coughing (N=168; 60%), and therefore leading them to rate their sleep quality as poor (N=102; 36.42%) (Table 5).

Discussion

Chronic lung diseases affect people of all ages, although they most commonly manifest in patients after the age of 60 [1,4], and the effects of the resulting disorders can be observed in various areas of life. Their emergence is the most important aspect affecting the assessment of a patient’s quality of life. As shown in the research conducted for the purpose of the present study, men suffer from COPD more often than women. A similar correlation was noted in studies by Klar [8] and Stelmach, the latter of whom also pointed out that mortality rates are the same regardless of sex [9]. The increased susceptibility of men to the disease may be caused by the fact that they are more likely to be heavy smokers and to work in harmful conditions. Recently, however, there have been changes in the proportion of women to men in the COPD patient population [7].

In the present study, no evidence was found among the surveyed patients that education affects their QoL. This is contrary to the pre-existing literature, which reveals a positive correlation between these variables. According to these studies, patients with higher education are more likely to have a greater knowledge of the disease, which results in a significantly better quality of life [10].

The analyses conducted as part of the present study have also revealed that COPD is more common among people living in urban than in rural areas, which is consistent with the findings of other researchers [2,3,4,5,7]. This finding does not seem surprising, as increased environmental pollution, which has a direct impact on the emergence of COPD, is typical of larger agglomerations [8,9].

However, the present study did not reveal a correlation between the place of residence and COPD incidence. It has been shown, however, that city dwellers constitute the majority of COPD patients. Other researchers claim that socio-demographic factors do not influence COPD development, but nevertheless, a higher incidence of the illness is observed in rural areas than in cities [1]. This correlation may stem from the fact that municipal waste is still used as a source of heat energy in rural households, which is one of the factors contributing to COPD incidence [11].

Compared to former smokers, active smokers require more frequent use of inhaled medications, as noted by Riley, who believes that smoking contributes to the emergence of 75% of cases. The remaining cases are caused by exposure to dust, chemical fumes, or air pollution [12]. Literature shows that smoking increases the risk of developing COPD in young people. Heavy smokers are at greater risk of developing COPD than non-smokers. What is more, Women who smoke are more likely to develop COPD than men who smoke [13]. It appears as though educating people on the factors causing COPD and aggravating its symptoms should therefore be of great importance. However, it turns out that education and specialist advice are not very effective in helping people quit smoking. It is thus recommended to combine counseling with pharmacotherapy, e.g., using nicotine patches. It should also be noted that the time it takes to quit smoking entirely depends largely on the severity of the addiction and is thus quite problematic for long-term smokers. Smoking is the main factor in the incidence of chronic obstructive pulmonary disease, and continuing to smoke causes the disease to progress and become more severe, which has a negative impact on the QoL of the patients [14].

The most common symptoms of COPD are dyspnea of effort and at rest, and coughing. Both symptoms were experienced by the majority of the respondents. Kupcewicz claims that shortness of breath is the second most common symptom after wheezing attacks, and is followed by coughing. Both of these symptoms are factors that limit the patient’s independent functioning in daily life. Due to fear of breathlessness, the patient limits activities that require significant physical effort. Therefore, they usually require support from their loved ones and the healthcare system, as well as encouragement to perform basic activities. It is also necessary to administer appropriate pharmacological treatment. COPD patients are forced to face both health-related and psychosocial problems. The disease also makes it difficult for them to perform basic everyday activities. Playing sports, climbing stairs, and, in advanced stages of the disease, even walking around the house become an issue [15]. Budnik’s observations also show that patients suffer most from dyspnea of effort and morning cough [16]. In her research, Dobosz observed that morning cough occurs in both men and women, most of whom belonged to older age groups [17]. Dyspnea is the primary symptom of this disease. It can be reduced or even eliminated, thereby improving patients’ QoL, through administering proper treatment and educating the patient on the correct use of inhalers [18].

Since shortness of breath and coughing are the leading problems in patients with COPD, spirometry testing is standard procedure in the treatment of this patient group. In the present research, most patients declared that they had undergone this test. Spirometry is one of the basic screening tests that should be performed to diagnose this condition. Undiagnosed individuals are at risk of a worse disease course and higher mortality. Labak also draws attention to the issue of diagnosis. He proposes supplementing the diagnosis with a CT scan of the chest, which is helpful in the early identification of individuals who are still in the pre-clinical stage of the disease [19].

Another issue affecting this group of patients is sleep disorders and the associated use of sleeping pills. Almost half of the respondents declared moderate problems in this regard, and one-third reported significant problems. What is more, most of the respondents reported taking sleeping pills. Tsai also notes that sleep disorders in COPD patients constitute a significant and common problem, caused primarily by the symptoms associated with the disease. The author focuses on the need to treat sleep disorders in order to improve patients’ QoL. She notes that there exist potential benefits of non-invasive positive pressure ventilation therapy in patients suffering from overlap syndrome with hypercapnia. Nighttime oxygen supplementation may help reduce sleep disorders in some subtypes of COPD patients [20].

The symptoms and problems discussed above may have contributed to a reduction in patient QoL by reducing their independent functioning. Therefore, the IADL scale was used to examine this potential relationship in the present study. Continued independent functioning is a fundamental element of maintaining a high QoL. It has been proven that in the surveyed group, complex activities of daily living cause little to no problem. Similar results were obtained in the study by Kuczyńska, who proved that half of the respondents rated the quality of their functioning as good, 33% as average, and 16% as poor. Based on the obtained results, she noted that reduced independence has a negative impact on the mental health of patients [21].

Research conducted as part of the present study has shown that COPD reduces patients’ QoL. A significant group of respondents declared the severity of symptoms and their impact on daily life was high or very high. It was also shown that most of the respondents can cope with basic daily activities and require assistance with only some of them. QoL assessment can be conducted through a subjective evaluation of the lives of chronically ill patients and an analysis of socio-demographic factors. Dobek points out that COPD is a disease that is diagnosed late and is not treated optimally. Services that could improve patients’ QoL, such as pulmonary rehabilitation, smoking cessation counseling, and palliative care, are not available to all patients. Limited access to specialists also constitutes an important issue [22]. Filipska also focuses on educating patients and their families about the elimination of risk factors, independent and correct medicinal administration, and the issue of quitting smoking [23]. Other authors point out that symptom aggravations occurring in the course of the disease significantly reduce QoL. This is additionally contributed to by limited access to health services and reduced independent functioning in life due to the advanced stage of the disease or age [24].

The results of the present research are consistent with those obtained by Fazekas-Pongor, which showed that COPD aggravation, existing comorbid conditions, and smoking were the most important factors negatively affecting the QoL of COPD patients [25]. For the purpose of the present study, no analysis was made regarding the effect of comorbidity incidence, which is a factor that could certainly affect the QoL of patients. This fact should be considered a limitation of the conducted analyses, and in subsequent studies, additional comorbid conditions diagnosed in the respondents should be taken into account as an important factor.

Continued research on COPD patients is an important aspect of ensuring that the therapeutic team is able to provide the best possible medical care. Furthermore, it serves to assess the daily functioning of patients at different stages of their life and the disease development, as well as the difficulties they may face on a daily basis. It allows doctors to gain an understanding of the idea of comprehensive patient care and to select of the most effective diagnostic and treatment methods. Based on the results of the study, certain modifications can be introduced to improve the patients’ quality of life.

Conclusions