Psychological factors and functional capacity as determinants of health-related quality of life in bronchiectasis

Integrating clinical severity with health-related quality of life, psychosocial, and functional measures is essential to fully capture the impact of the disease and to inform patient-centred treatment strategies in patients with bronchiectasis. Accordingly, this study aimed to investigate the determinants of health-related quality of life in non-cystic fibrosis bronchiectasis, examining how psychological factors, disease severity, and functional exercise capacity interact in patients' self-reported quality of life. This prospective observational study included patients with non-cystic bronchiectasis (NCFB) aged 18-60 years. Disease severity was classified using Bronchiectasis Severity Index (BSI). Assessments included the Hospital Anxiety and Depression Scale (HADS), Medical Outcomes, Short-Form Health Survey (SF-36), Leicester Cough Questionnaire (LCQ), Quality of Life in Bronchiectasis (QOL-B), and Six-Minute Walk Test (6MWT). Pearson correlations and multiple linear regression were used to examine associations between psychological variables and outcomes. Thirty-one patients participated (54.8% female; mean age 52.45 ± 15.3 years), and 83.9% had mild - moderate disease. HRQoL was related to anxiety, depression, and functional exercise capacity, and anxiety was also associated with cough severity. Anxiety was negatively associated with the SF-36 Mental health domain (β = -1.80; p = 0.03) and the QOL-B Emotional functioning domain (β = -2.79; p = 0.01), while depression was associated with SF-36 Mental health (β = -2.26; p = 0.01). No association was found between prognostic severity of the disease and HRQoL. Psychological factors and exercise capacity were the main determinants of HRQoL in patients with mild to moderate NCFB, highlighting the importance of simple functional markers, such as the six-minute walk test (6MWT) and mental health assessment, in clinical evaluation and treatment planning.