Doctors Underestimate Emotional Impact Of COPD Exacerbations - Patients Fear Being Hospitalised Or Dying

Main Category: COPD
Also Included In: Psychology / Psychiatry
Article Date: 16 Jul 2006 - 0:00 PDT

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New data from a multinational, interview-based patient study, published today in the medical journal CHEST, shed light on COPD patients' comprehension, recognition, and experience of exacerbations and the burden associated with these events.

Exacerbations are known to impair health-related quality of life (HRQL) in patients with COPD and increase the risk of mortality2. Today's paper also brings valuable insight to the burden of exacerbations as experienced by patients. The study shows that physicians often underestimate the psychological impairment experienced by patients during an exacerbation. Exacerbations cause substantial anxiety, patients reported; 12% stated they worry about dying, 10% that they worry about suffocating, 10% that they will experience a permanent worsening of their condition and 8% that they will be hospitalised. A majority of patients reported that besides influencing on their activities in daily live, a worsening significantly affect their mood causing a variety of negative feelings, such as depression, irritability/bad temper, anxiety, isolation, anger, and guilt. Moreover 42% stated that exacerbations affected their personal relationships.

"The observation that physicians fail to appreciate the considerable changes to the patient's emotional wellbeing demonstrates a communications gap between patients and their doctors and represents a dilemma in the management of COPD. Such underestimation of the burden of exacerbations may contribute to under treatment of COPD by healthcare professionals. This is worrying since the existing evidence shows that early medical intervention improves recovery time, minimises the risk of hospitalisation and improves health-related quality of life3. A clear link between increased exacerbation frequency and risk of mortality has also been demonstrated4," explained study lead-investigator, Professor Romain Kessler, Department of Pulmonology, Hopitaux Universitaires de Strasbourg in France.

The study was conducted with 125 patients diagnosed with COPD from France, Germany, Spain, Sweden and the UK. The patients were aged >= 50 and had experienced a minimum of 2 exacerbations during the previous year. 65% of patients were male COPD patients. During the previous 12 months, patients had experienced a mean of 4.6 exacerbations with an average duration of 2 weeks and a mean recovery time of 10 days. Notably, 20% felt that they had not returned to their previous state of health after an exacerbation, demonstrating the importance of reducing these events.

The importance of improving patients' health-related quality of life (HRQL) was further supported by data from a pooled analysis of two multinational randomised controlled clinical trials recently presented at the COPD5 congress in Birmingham, UK5 6. The analysis showed that HRQL was the strongest predictor of mortality in COPD5 and that the addition of budesonide to formoterol (Symbicort(R)) and/or a short-acting bronchodilator reduced the risk of mortality compared to bronchodilators alone6.

Another interesting finding supporting the observed communications gap between healthcare professionals and patients is that, although a term commonly used by physicians, only 1.6% of patients understood what was meant by the widely used clinical term 'exacerbations' (in the study defined as a worsening of respiratory symptoms such that bronchodilators, and/or oral corticosteroids, and/or antibiotics, and/or oxygen therapy, and/or hospitalisation were required). Instead, patients used simpler, easier to understand terms to describe a worsening of their condition. The single term used most often by patients to describe an exacerbation is 'crisis', underscoring the seriousness with which patients view the worsening of their condition.

Two-thirds of patients stated they are aware of the symptoms associated with their condition getting worse, recognising them as warning signs. Most patients (85%) experience the same symptoms from one exacerbation to another - 'breathlessness' being the most commonly recollected warning sign. At the onset of an exacerbation, 33% of patients reported that they react by self-administering their medication while only a minority contacts their physician.

"The observation that two-thirds of patients are easily able to identify consistent warning signs is new and important. The finding suggests a window of opportunity for intervening and preventing a full-blown deterioration. The fact that patients show a willingness to undertake self-medication moreover suggests a potential role for self-management based on individual action plans," concluded Professor Kessler.

The study was conducted with the support of AstraZeneca R&D, Lund, Sweden.

AstraZeneca are the manufacturers of Symbicort(R), a combination of the inhaled corticosteroid budesonide and rapid- and long-acting beta-agonist formoterol, which is indicated for the treatment of asthma and COPD.

References:

1 - Romain Kessler, Elisabeth Stohl, Claus Vogelmeier, John Haughney, Elyse Trudeau, Claes-Goran Lofdahl, and Martyn R. Partridge. Patient Understanding, Detection, and Experience of COPD Exacerbations: An Observational, Interview-Based Study. Chest 2006;130 133-142.

2 - Calverley PM, Boonsawat Z, Zhong N, Peterson S and Olsson H. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Resp J 2003; 22; 912-919.

3 - Wilkinson TM, Donaldson GC, Hurst JR, et al. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004; 169:1298-1303.

4 - Soler-Cataluia JJ, Martinez-Garcia M, Romen Senchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease Thorax 2005;60:925-31.

5 - Paul Jones, Peter Calverley, Thomas Larsson, Stefan Peterson. St Gerge's respiratory questionnaire (SGRQ) scores may help identify COPD patients at increased wisk of death over 1 year. Presentation at COPD5, Birmingham, UK, 28 June 2006, Abstract 34.

6 - Peter Calverley, Paul Jones, Thomas Larsson, Stefan Peterson. Preventing mortality in COPD: The value of inhaled budesonide added to bronchodilators. Presentation at COPD5, Birmingham, UK, 28 June 2006, Abstract 35.

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