Comorbidities and quality of life in obstructed adults in a primary care setting

Introduction Comorbidities are known to impair Quality of Life (QoL)in patients with chronic obstruction pulmonary disease. A poor QoL is associated with higher dyspnoea perception. How comorbidities influence QoL in these patients is limited and needs clarification. Aim To study the role of dyspnoea perception in the relationship between comorbidities number and QoL in obstructed and not obstructed adults in a primary care setting. Methods Seventeen general practitioners participated to the study: 566 adults, attending the Practitioner's study for any reason, performed spirometry and fulfilled a respiratory questionnaire between January and June 2014. 259 adults (148 M, aged 40-88) accepted to perform all the procedures: spirometry, IMCA and QoL(SF-36 through Physical Health "PCS" and Mental Health components) questionnaires, evaluation of comorbidities and mMRC Dyspnoea Scale. For screening purpose a cut-off of FEV1/FVC<70% was considered as marker of airway obstruction (AO). Results The 25% of sample showed AO. No significant difference in mMRC score, neither comorbidities number nor PCS was found between AO and not AO. Comorbidities number and PCS were inversely related in both AO (p<.001) and not AO (p<.001); mMRC and PCS were inversely related in both AO (p=.001) and not AO (p<.001). Mediation analysis (Hayes Process) showed that the relation between comorbidities number and PCS was totally mediated by mMRC in AO and partially in not AO. Conclusions We conclude that the effect of comorbidity number on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in obstructed adults also in a primary care setting may be a useful indicator for evaluating the patient global health.