Failure to Report Exacerbations Puts COPD Patients Lives at Risk

Main Category: COPD
Article Date: 06 Sep 2004 - 11:00 PDT

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UK study shows more than half of COPD patients fail to report life-threatening attacks

A major new UK study shows that more than half of patients with chronic obstructive pulmonary disease (COPD) are putting their lives at risk by failing to tell their GP when they experience an exacerbation(chest infection)1,2 - described by some as a feeling of suffocation or drowning3.

The Blackpool study, presented today at the European Respiratory Society (ERS) annual congress in Glasgow, shows that 52% of exacerbations in patients with moderate to severe COPD and 43% in those with milder disease were not reported to their GP.1,2 Exacerbations have a serious impact on a patient's quality of life and increase the risk of disease progression and mortality.4,5,6 Furthermore, once a patient has had an exacerbation, the likelihood of them having a subsequent attack increases.7,8,9

"Despite earlier findings from the Blackpool study in which the experience of hospitalised patients was rated worse than death,* these findings show that patients in primary care are not consulting their GP at the time of exacerbation", commented lead investigator, Dr John O'Reilly, Consultant Physician at University Hospital Aintree, Liverpool in the United Kingdom. "Exacerbations represent a sustained worsening of the COPD patient's condition, necessitating a change in medication and by not reporting their exacerbations, COPD patients are not receiving treatment needed to manage their condition and help prevent further episodes."

The 12-month Blackpool Study involved 309 COPD patients from the UK. Patients used diary cards to record exacerbations as a worsening of their symptoms and need for medicines like antibiotics and oral steroids. Most of the study patients experienced two exacerbations over the course of the study.1,2

"Given the seriousness of an exacerbation, the low number of patients reporting these to their GP or nurse is very disappointing and somewhat shocking", commented Dame Helena Shovelton, Chief Executive of the British Lung Foundation. "It is important that patients understand that the treatment and prevention of exacerbations can make a real difference to their lives. By reporting symptoms in an accurate and timely way, patients can help prevent further attacks and reduce the impact that this already debilitating disease has on their life."

Exacerbations represent a major risk for COPD patients with around one in eight being admitted to hospital with an exacerbation;10 and of those almost half may die within a year.11 These latest figures show the need for more effective treatment and management of COPD exacerbations in order to reduce hospitalisation and death. However, there is growing evidence to show that careful management can reduce the risk of exacerbations and therefore slow the progression of the disease.3

New data presented at the ERS shows that effective exacerbation prevention is possible.12,13 In the study, Seretide (a combination of salmeterol and fluticasone propionate), reduced the risk of exacerbations requiring oral corticosteroids by 42%12 and provided a cost effective method of reducing the financial burden of exacerbations.13

Preventing exacerbations is key in effective management of COPD. Research shows that 25% of patients require more than five weeks and 7% more than three months, before lung function returns to previous levels following an attack.14 A higher frequency of exacerbations in COPD is also related to:4,15

-- More rapid decline in lung function

-- More chronic respiratory symptoms

-- More hospital admissions

-- Greater mean length of stay in hospital

Emergency hospital admissions account for up to 84% of the costs directly associated with COPD and these have risen by over 50% in the last nine years.16 With some estimates placing the annual cost to the NHS of the disease at �817 million,17 there is a clear and urgent need to improve management of the disease with increased emphasis on preventing exacerbations.

The need to address the growing problem of COPD has led to the formation of The Exacerbations Task Force, a group of experts and patient groups who called a summit at this year's ERS congress to drive improvements in how COPD is managed. The task force has announced the following call to action:18

-- Increase awareness that COPD exacerbations can be prevented and treated

-- Increase patients' knowledge about their disease and provide clear terminology to define and explain exacerbations

-- Develop "pathways" for the prevention and treatment of exacerbations

-- Provide model programmes for multidisciplinary care

-- Encourage use of spirometry in patients presenting with exacerbations to confirm a COPD diagnosis

COPD is the UK's only major cause of death that is increasing19 with nearly 900,000 cases diagnosed in the UK.20 During an exacerbation, patients experience a rapid worsening of uncontrolled symptoms that leave them fighting for breath. Patients can also experience confusion, fever and excessive sleepiness - a sign of carbon dioxide poisoning, which is extremely serious and possibly fatal.21

- ENDS -

For further media information, please contact:
Catherine Hartley / Gareth Field - Ketchum
(020) 7611 3607 / (020) 7611 3668
catherine.hartley@ketchum.com / gareth.field@ketchum.com

Notes to editors:
COPD stands for Chronic Obstructive Pulmonary Disease.
Add in selected facts and figures from core claims.

The COPD Exacerbations Task Force is a group composed of experts from secondary care, primary care, nursing and third party patient organisations, which aims to address the increasing burden of these exacerbations. The task force have announced the following call to action:

The COPD Exacerbations Task Force was launched this at the ERS and is sponsored by an educational grant from GlaxoSmithKline.

1 O'Reilly J, Williams A. E., Rice L. and Holt K. Incidence and impact of healthcare defined exacerbations amongst a cohort of primary care COPD patients, Abstract to be presented at ERS September 2004

2. 2 O'Reilly J, Williams A.E., Rice L. and Williams A. E. Exacerbation prevention - should we revisit the thresholds for intervention? Poster to be presented at ERS September 2004

3 Breathing Fear: The COPD Effect. British Lung Foundation. 2003

4. 4 Seemungal TAR, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: 1418-1422

5 Spencer S, Jones P. Annual rate of health status decline in COPD patients is significantly related to frequency of acute exacerbations. Eur Respir J 1999; 14 (suppl 30): 19S.

6 Spencer S, Jones PW. Patients with recurrant exacerbations of chronic bronchitis (AECB) have poorer health and recover more slowly and less completely following an acute episode. Am J Respir Crit Care Med 2001: 163 (5): A769.

7 Seemungal TAR et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. AM J Respir Crit Care Med 1998; 157: 1418-1422.

8 Garcia-Aymerich et al, 2003.

9. 9 Conners A. F. et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. Am J Respir Crit Care Med 1996; 154: 959-967

10 Anto JM, Vermeire P, Vestbo J, Sunyer J. Epidemiology of chronic obstructive pulmonary disease. Eur Respir J 2001; 17: 982-994.

11 Stoller JK. Acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002; 346(13): 988-994.

12 Hunjan, M.K. and Williams D.T. Salmeterol / fluticasone propionate combination is clinically effective in avoiding exacerbations in patients with moderate / severe COPD Abstract to be presented at ERS September 2004

13 Hunjan, M.K. and Williams D.T. Costs of avoiding exacerbations in patients with chronic obstructive pulmonary disease (COPD) treated with salmeterol / fluticasone proprionate combination (Seretide) and salmeterol. Abstract to be presented at ERS September 2004

14 Seemungal TAR, Donaldson GC, Bhowmik A, Wedzicha JA. Frequent COPD exacerbators show accelerated decline in lung function. Am J Respir Crit Care Med 2001; 163(5): A772

15 Seemungal TAR, Donaldson GC, Bhowmik A, Wedzicha JA. Frequent COPD exacerbators have more severe exacerbations. Am J Respir Crit Care Med 2001; 163(5): A769

16 Lung & Asthma Information Agency. Trends in emergency hospital admissions for lung disease. Factsheet 2201/4

17 National Respiratory Training Centre. Impact of Respiratory Conditions: a guide for Primary Care Organisations. Warwick: NRTC (2002)

18 Celli B. The Global Burden of COPD Exacerbations. To be presented at ERS September 2004.

19 Murray CAL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349:1498-1504

20 Chronic Obstructive Pulmonary Disease. National clinical guidelines on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax March 2004; 59 (supply 1).

European Federation of Allergy and Airways Associations http://www.efanet.org/copd last accessed on 25th August 2004



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