Background: Patients with COPD experience a consistent disability which leads to a
deterioration in their Health related quality of life (HRQL). In Tunisia, this topic has not yet been
Objective: This study aims to assess the HRQL of patients with COPD in Tunisia and to identify
possible predictors of HRQL.
Methods: A cross-sectional study was carried out in the two main primary care centers in Sousse over
a period of three months. HRQL was assessed by the Medical Outcomes Study Short form 36 (SF-
36). Clinic and socio demographic data were collected from patients' records. The population was
divided into four subgroups, high and low components' scores. Univariable analysis and multivariable
analysis were used to identify predictive factors of HRQL.
Results: A total of 335 patients have participated with a mean age of 66.70±11.60. Physical
component's median was 37.08 and that of mental component was 40.70. compared to age 40-49, the
age groups associated independently to impaired PQL and MQL were 70-79 (OR=19; 95% CI: 4-89
and OR=6; 95% CI: 1.20-17, respectively), and ≥80 (OR=19; 95% CI: 4-99 and OR=6.04; 95% CI:
1.30-26, respectively). Age group 60-69 was associated only to impaired PQL (OR=9; 95% CI: 2-40).
Analysis of associations between PQL and the severity of the disease showed that the ORs of severe
stage of COPD (OR= 3.70; 95% CI: 1.20-11) and very severe stage (OR=31.50; 95% CI: 9.20-90
and) were significant. While in MQL, ORs of moderate (OR=11.40; 95% CI: 1.40-90), severe
(OR=44.50; 95% CI: 5-357), and very severe stages of COPD (OR=233; 95% CI: 28-280) were
The ORs of stages 4 and 5 of dyspnea were significant only in PQL (OR= 15; 95% CI: 1-135 and
OR=17; 95% CI: 8-180, respectively).
In addition, compared to having no comorbidities, the OR of two co-morbidities or more (OR=2.80;
95% CI: 1.30-5 and OR=3.40; 95% CI: 1.70-7) was significantly higher (OR=1.18; 95% CI: 0.50-2
and OR=1.20; 95% CI: 0.60-2.40). Dyspnea was independently associated with only PQL.
Conclusion: Patients with COPD had an impaired HRQL associated independently with age, disease
severity and co-morbidity. Health care professionals should take into account these predictive factors
in order to improve the general health condition of COPD patients.