• Carlos H Martinez, Alejandro A Diaz, Amit D Parulekar, Stephen I Rennard, Richard E Kanner, Nadia N Hansel, David Couper, Kristen E Holm, Karin F Hoth, Jeffrey L Curtis, Fernando J Martinez, Nicola A Hanania, Elizabeth A Regan, Robert Paine, Christine T Cigolle, MeiLan K Han, and COPDGene and SPIROMICS Investigators.
• Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI. Electronic address: carlosma@umich.edu.
• Chest. 2016 Apr 1; 149 (4): 927935927-35.

ObjectiveYounger persons with COPD report worse health-related quality of life (HRQL) than do older individuals. The factors explaining these differences remain unclear. The objective of this article was to explore factors associated with age-related differences in HRQL in COPD.MethodsCross-sectional analysis of participants with COPD, any Global Initiative for Chronic Obstructive Lung Disease grade of airflow limitation, and ≥ 50 years old in two cohorts: the Genetic Epidemiology of COPD (COPDGene) study and the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). We compared St. George's Respiratory Questionnaire (SGRQ) scores by age group: middle-aged (age, 50-64) vs older (age, 65-80) adults. We used multivariate linear modeling to test associations of age with HRQL, adjusting for demographic and clinical characteristics and comorbidities.ResultsAmong 4,097 participants in the COPDGene study (2,170 middle-aged and 1,927 older adults) SGRQ total scores were higher (worse) among middle-aged (mean difference, -4.2 points; 95% CI, -5.7 to -2.6; P < .001) than older adults. Age had a statistically significant interaction with dyspnea (P < .001). Greater dyspnea severity (modified Medical Research Council ≥ 2, compared with 0-1) had a stronger association with SGRQ score among middle-aged (β, 24.6; 95% CI, 23.2-25.9) than older-adult (β, 21.0; 95% CI, 19.6-22.3) participants. In analyses using SGRQ as outcome in 1,522 participants in SPIROMICS (598 middle-aged and 924 older adults), we found similar associations, confirming that for the same severity of dyspnea there is a stronger association with HRQL among younger individuals.ConclusionsAge-related differences in HRQL may be explained by a higher impact of dyspnea among younger subjects with COPD.Trial RegistryClinicalTrials.gov; No.: NCT00608764 and No.: NCT01969344; URL: www.clinicaltrials.gov.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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