New Research Reveals the Real-Life Impact of COPD On Patients - Avoiding The Burden Of Exacerbations Matters Most of All

Main Category: COPD
Article Date: 27 May 2004 - 11:00 PDT


New research amongst COPD patients and physicians reveals that avoiding the burden of exacerbations matters most of all to patients.1,2,3 Presented for the first time today at the ATS congress,1,2,3,4 this research demonstrates that exacerbations associated with COPD exert a huge physical and psychological impact on patient's lives.2 These 'crisis' episodes are what concern patients most and striving to avoid these should be the focus of COPD management.

In addition to everyday symptoms, patients with more severe COPD suffer acute 'exacerbations' of symptoms. An exacerbation is a deterioration in the patient's clinical status, with worsening of respiratory symptoms, such as coughing, wheezing, sputum production and shortness of breath which in its severe form requires medical intervention, often resulting in being housebound, bed-ridden or even hospitalised.

An exacerbation usually develops gradually over a couple of days and the duration varies from a few days to several weeks or even months. Recovery can be very slow and may require rehabilitation. Moreover, many patients do not make a complete recovery from an exacerbation.5

Svein Erik Myrseth, president of the European Federation of Allergy and Airways Diseases Patients' Associations (EFA) commented: "This new research really confirms the extent to which exacerbations impact on patients' health-related quality of life. We need to open our eyes to the growing burden of COPD, recognising that exacerbations are not only a significant cause of death but also have a huge burden on day-to-day well-being. Any measure that can be taken to allow patients to maintain their daily lives is really important. We must not underestimate the fear suffering an exacerbation can build in patients and EFA encourage the COPD community to consider addressing exacerbations, along with symptom control, to ensure we can provide the best health-related quality of life expectation for patients."

The international, cross-sectional, qualitative study was conducted across Europe amongst males and females suffering from COPD, aged 50 years and over - in total 105 patients.1,2.3,4 The research involved face-to-face interviews with patients but also patient case reports completed by their doctors. Specifically, the study results showed:

- COPD exacerbations impose considerable burden on patients in terms of limitations in activities of daily living (ADL) and reduced psychological wellbeing.2

- Not being housebound and avoiding admission to hospital as a result of an exacerbation are the most important outcomes for COPD patients, even more important than improving symptoms.1

- Physicians do recognise the burden exacerbations exert on patients lives, yet the severity can be underestimated when compared with official guideline recommendations.3

- Only a few of the COPD patients know what an 'exacerbation' is and the majority use different words to describe their episodes of worsening in COPD such as 'crisis', 'attack' and 'chest infection'.4

In particular, the research illustrated the difference between the normal stable state of COPD and periods of symptom exacerbation for patients. Physicians were asked to score the impairment COPD and exacerbations had on their patient's physical activity and also their psychological well-being.3 Impairment of physical and psychological well-being was considered comparable during stable COPD but that exacerbations caused more extreme impairment and especially in relation to physical impairment.3

Dr John Haughney, GP in Glasgow, UK, member of the study scientific board commented: " Our research confirms the enormous impact that exacerbations have on people with COPD. Clinicians must be sympathetic to the emotional needs of patients, in addition to managing the disease, to ensure quality of life is maximised. What has become evident is that COPD patients accept and manage with the symptoms they suffer but that exacerbations are what really causes them distress. Preventing exacerbations is an important treatment goal in COPD. Since we know that frequent exacerbations are linked to an increased lung function decline6, it is important to try to reduce this potentially fatal deterioration in lung function".

These data underscore the need for effective treatments to prevent exacerbations in COPD. Two studies comprising more than 1800 patients treated with Symbicort(R) (budesonide/formoterol) have shown that the number of exacerbations can be decreased by 27% and 23% respectively compared with formoterol alone7,8. Additional data analysis of these studies presented at ATS has shown that for approximately every two patients treated with Symbicort compared to a long acting bronchodilator such as formoterol, one exacerbation requiring medical intervention is avoided.9

There are 600 million COPD sufferers worldwide; making COPD one of the world's most common chronic diseases.10 Most cases of COPD develop after repeatedly breathing in fumes and other things that irritate and damage the lung and airways. Cigarette smoking is the most common irritant that causes COPD.11 By 2020, COPD is estimated to become the third leading cause of death.12

Notes to editors
Further information is provided on:
- COPD and Exacerbations: Background Information
- COPD and Exacerbations: Key Facts and Figures
- Qualitative Patient Study on Exacerbations: Study Design and Methodology

Definition of an Exacerbation

"The exacerbation of respiratory symptoms requiring medical intervention [oral steroids and/or antibiotics and/or or hospitalisation]."

In addition to their everyday symptoms, patients with more severe COPD suffer acute exacerbations (of symptoms). An exacerbation is a deterioration in a patient's clinical status, with worsening of respiratory symptoms, such as coughing, wheezing, sputum production and shortness of breath. Exacerbations may also be accompanied by non-specific complaints such as malaise, insomnia, fatigue, depression, and confusion. For patients with severe COPD, exacerbations tend to be associated with cardiac symptoms as well as respiratory symptoms.

Health-Related Quality of Life (HRQL): Refers to the overall enjoyment of life and an individual's sense of well-being and ability to perform various tasks.

Health Status: Refers to the level of health of the patient as subjectively assessed by the individual or by more objective measures.

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References

1. Haughney, J. Conjoint analysis of patient perceptions of COPD exacerbations. Abstract presented at ATS, 2004.
2. Volgelmeier, C. Burden of exacerbations in COPD: The patient's perspective. Abstract presented at ATS, 2004.
3. Kessler, R. Physician assessment of COPD severity and physical and psychological burden on patients. Abstract presented at ATS, 2004.
4. Partridge, M. Patient understanding of the term 'exacerbation'. Abstract presented at ATS, 2004.
5. Seemungal TAR, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA. Time course and recovery of exacerbations in patients with COPD. Am J Respir Crit Care Med 2000; 161:1608-1613.
6. Donaldson GC, Seemungal TAR, Bhowmik A, Wedzicha JA. Relation between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002;57:847-852
7. Szafranski W, Cukier A, Ramirez A, Menga G, Sansores R, Nahabedian S, Peterson S, Olsson H. Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J 2003;21(1):74-81.
8. Calverley PM, Boonsawat W, Cseke Z, Zhong N, Peterson S, Olsson H. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J 2003;22(6):912-9.
9. Halpin, D. Treatment costs and number needed to treat (NNT) with budesonide/formoterol to avoid one exacerbation of COPD. Abstract presented at ATS, 2004.
10. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy For the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease NHLBI/WHO Workshop Report, 2002. http://www.goldcopd.com
11. National Heart, Blood and Lung Institute. Diseases and conditions index. What causes COPD? Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_Causes.html
12. Murray CJ, Lopez AD. Alternative projection of mortality by cause 1990-2020: global burden of disease study. Lancet

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