Which Factors Affect Voice-Related Quality of Life in COPD?

Patients with chronic obstructive pulmonary disease (COPD) experienced lower voice-related quality of life (VRQOL) as a result of their disease, as measured by their risk of dysphagia and changes in peak expiratory flow (PEF), according to a recent study.

Writing in Journal of Voice, researchers investigated how VRQOL, pulmonary function, risk for dysphagia, and dyspnea symptoms are related to the different levels of COPD severity. They also aimed to verify which of these variables may be factors related to VRQOL.

COPD negatively affects both physical and psycho-emotional functioning, lowering one’s quality of life. Respiratory and muscle damage from COPD can affect one’s voice, an important tool in everyday life. Examining self-perceptions of COPD and VRQOL is important to improve clinical treatment for patients, the researchers wrote, as VRQOL effects in the disease are poorly understood.

This observational, quantitative, retrospective cross-sectional study included 37 patients with COPD who were treated in a pulmonary rehabilitation program (PRP) at a university hospital in Brazil. Patients were aged 35 to 89 years, 48.6% were male, and 51.4% were female.

PEF was measured in all patients. Researchers used the Modified Medical Research Council (mMRC) scale to assess dyspnea and the Questionnaire for Dysphagia Screening (QDS) to examine the patients’ risk for dysphagia. If the patient indicated they had at least 1 “moderate symptom,” they were considered at risk for dysphagia.

The investigators also used the COPD Assessment Test (CAT) to look at the health status of each patient; the CAT quantifies cough, phlegm, chest tightness, shortness of breath when climbing hills/stairs, limitation of household activities, confidence when leaving home, and sleep and energy.

To quantify the impact of a voice problem on quality of life, the researchers used the VRQOL Questionnaire, which looks at 2 domains: physical and socio-emotional. The physical domain refers to the patient’s physical functionality. Scores below the cutoff points mean that a voice problem interferes with the patient’s daily activities.

The severity of COPD was categorized by forced vital capacity (FEV₁) as follows: an FEV₁ of at least 80%, mild; between 50% and less than 80%, moderate; between 30% and less than 50%, severe; and less than 30%, very severe.

A multivariate linear regression analysis examined the correlation of the VRQOL score to PEF and dysphagia risk as measured by the QDS. Study results showed that as COPD severity increased, VRQOL decreased and that risk factors for dysphagia were related to voice quality of life.

Results showed that 51.1% of changes in the VRQOL score could be predicted by PEF and QDS, mostly due to the presence of risk factors for dysphagia.

In addition, results showed a moderate link between total VRQOL scores and physical domain VRQOL scores and the CAT. As the health status of a patient declined, as measured by higher CAT scores, VRQOL scores fell, showing a reduction in VRQOL.

Limitations of the study include the use of nonprobability sampling and the absence of a control group consisting of healthy individuals. The researchers also cited scarce literature exploring the relationship between variables analyzed in patients with COPD.

This study is among the few that evaluates factors related to VRQOL in patients with COPD in a pulmonary rehabilitation program. These data indicate the need for vocal interventions for these patients in order to improve their quality of life and may aide clinicians in the planning of vocal interventions, the authors said.

Reference

dos Anjos Palagida da Silva G, Feltrin TD, dos Santos Pichini F, Cielo CA, Pasqualoto AS. Quality of life predictors in voice of individuals with chronic obstructive pulmonary disease. J Voice. Published online July 11, 2022. doi:10.1016/j.jvoice.2022.05.017