Quality of Life and Symptom Burden Among Patients with Chronic Obstructive Pulmonary Disease in Pakistan

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is associated with airflow limitation, substantial symptom burden, functional restriction, psychological morbidity, and impaired health-related quality of life (HRQoL). Patient-reported measures may capture disease burden not fully reflected by spirometric severity. Objective: To assess HRQoL and symptom burden among patients with COPD in Pakistan and examine their relationships with airflow limitation, respiratory symptoms, and psychological characteristics. Methods: This cross-sectional study included 93 patients with COPD attending Johar Institute of Professional Studies from March to September 2025. Clinical variables included demographics, smoking and biomass exposure, COPD duration, FEV₁ percentage predicted, and GOLD stage. Symptom burden was assessed using the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scale, while HRQoL was evaluated using the St George’s Respiratory Questionnaire (SGRQ) and estimated EQ-5D index. Depression and anxiety were classified using PHQ-9- and GAD-7-based criteria. Data were analysed using SPSS version 26.0. Results: Mean age was 60.43±8.69 years; 69.9% were male. GOLD 2 disease was present in 68.8%, while 21.5% had GOLD 3–4 disease. Mean CAT and SGRQ scores were 25.19±9.97 and 59.41±15.34, respectively; 79.6% had CAT >10 and 80.6% had mMRC ≥2. CAT correlated strongly with SGRQ (ρ=0.869) and inversely with EQ-5D (ρ=−0.846), while FEV₁ showed weaker correlations. CAT, FEV₁, and probable depression remained independently associated with HRQoL. Conclusion: Pakistani patients with COPD experienced marked symptom burden and HRQoL impairment, supporting multidimensional assessment beyond spirometry alone. Keywords: COPD; quality of life; CAT; SGRQ; dyspnea; EQ-5D; Pakistan.