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Volume 3 Issue 171 Published - 14:00 UTC 08:00 EST 24-Sep-2001 Next Update - 14:00 UTC 08:00 EST 25-Sep-2001
| Editor: Susan K. Boyer, RN © RAmEx Ars Medica, Inc. All rights reserved. |
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 Patients With COPD May Underestimate The Severity Of Symptoms, Forego Available Therapies
People living with chronic obstructive pulmonary disease (COPD) -- an umbrella term which includes emphysema and chronic bronchitis that decreases airflow in and out of the lungs -- may be suffering unnecessarily because they underestimate the severity of their symptoms. This is according to results of the first international survey of the disease, announced at the 11th European Respiratory Society's annual congress held in Berlin, Germany. Key International Findings Confronting COPD in North America and Europe provides important new data and insights into a disease that is set to become the third leading cause of death in the developed world by 2020(1). The survey explores issues regarding the frequency and severity of symptoms, the burden of illness, healthcare utilization, disease management and treatment, and quality of life issues. The survey results reveal that while many patients acknowledge severe impairment in their quality of life, they underestimate their symptoms when speaking to their doctor. For example, 36% of patients with the most severe breathlessness described their condition as 'mild' or 'moderate,' as did 60% of those with the next most severe degree of breathlessness. As a result, the disease may be inadequately treated with one third of people suffering from the disease not taking medication for their condition. Commenting on the survey findings, Professor Marc Decramer, Professor of Medicine, at the Katholieke Universiteit Leuven in Belgium said, "these results provide a snapshot of the debilitating nature of COPD, which affects some of the most fundamental aspects of everyday life. What we are seeing is that many people with COPD feel they are not in control of their breathing and often panic when they cannot get their breath. Yet many patients do not adequately convey their degree of suffering to their doctor and therefore do not get the treatment or support they require." The study showed that a substantial proportion of COPD patients say their condition limits what they can do in sports and recreation (64%), normal physical exertion (59%), household chores (43%), social activities (40%), sleeping (38%), and family activities (34%). Additionally, more than one- third of patients with COPD (36%) report that their condition keeps them from working, limits their ability to work, or caused them to miss work. Visits to the doctor are relatively frequent for COPD patients. * Nearly a quarter (24%) see a doctor at least once a month and two-thirds (66%) see a doctor every six months because of their disease. * 13% of patients were hospitalized for their condition in the past year and an additional 29% had other emergency medical visits in the past year. However, despite these hospitalizations and reduced quality of life, there is a significant anomaly regarding the way patients perceive the severity of their condition: * Nearly one-third (29%) who are short of breath while sitting or lying still and 29% of patients who are short of breath while talking describe their symptoms as 'well' or 'completely' controlled. * Additionally, in those whose condition restricts normal physical exertion, 44% say their symptoms are 'well' or 'completely' controlled. Professor Marc Decramer, concluded, "ultimately, the results show that patients may not fully understand the implications of their disease, or how it could be managed more effectively to give them small improvements in their quality of life." He said, "if patients could be encouraged to discuss their symptoms and the impact COPD has, then they could be treated more effectively." Key US Findings Confronting COPD in America, the US subset of this international survey, reveals that millions of Americans are suffering from shortness of breath so severe it interferes with even the most basic daily activities. Of the nearly 600 people with COPD interviewed in the US: * 28% have difficulty breathing even when sitting or lying still. * Almost one in four (23%) said their condition has made them an invalid; eight percent are too breathless to leave home. The survey paints a picture of a disease that takes a tremendous toll on patients. Describing their worst three months in the previous year, 58% said they had shortness of breath every day and 23% of patients said symptoms woke them up every night. In general, half of all US COPD patients (51%) say their condition limits their ability to work. Many say it also limits them in normal physical exertion (70%), household chores (56%), social activities (53%), sleeping (50%) and family activities (46%). The US survey also reveals that a considerable number of patients underestimate the severity of their condition and/or overestimate the degree of control they have achieved. More than a third (36%) of those whose symptoms fit the criteria for the most severe degree of breathlessness describe their condition as "mild" or "moderate." One in four (25%) of those with the most severe degree of breathlessness say their COPD has been "completely controlled" or "well controlled" in the past year. The survey also points to the need for more education about effective COPD management. Although 36% of patients say they "completely" understand how best to manage the condition, just one percent of doctors say this about their patients. Still, a majority of patients (76%) and doctors (69%) agree that there is a "strong need" for better education about COPD. Background on COPD Chronic obstructive pulmonary disease (COPD) is currently the fifth most common disease and the fourth cause of death in the world(2). It is also the fourth leading cause of death in the US(3) and affects and estimated 21.7 million Americans(4). Long-term smoking is the most frequent cause of COPD. It accounts for 80- 90% of all cases. A smoker is 10 times more likely than a non-smoker to die of COPD. Other risk factors include heredity, second-hand smoke, exposure to air pollution at work and in the environment, and a history of childhood respiratory infections. The most common symptoms of COPD include shortness of breath, chronic coughing, chest tightness, a greater effort to breathe, increased mucus production and frequent clearing of the throat. About the Survey Confronting COPD in North America and Europe was conducted by Schulman, Ronca and Bucuvalas, Inc., a research firm specializing in health issues. Interviews were completed between August 2000 and January 2001 with 3,265 COPD patients and 905 physicians in the United States, Canada, France, Germany, Italy, The Netherlands, Spain and the United Kingdom. The sample was identified by systematically screening a national sample of 201,921 households in the eight countries to find patients 45 years and older who had been diagnosed with COPD, emphysema or chronic bronchitis, or whose symptoms matched a strict definition of chronic bronchitis(5). A national sample of 905 physicians -- 625 primary care physicians and 280 respiratory specialists -- was also interviewed in the eight countries as part of the survey. Interviews covered a wide range of attitudes, beliefs and behaviors related to COPD. The survey was funded by the GlaxoSmithKline (NYSE: GSK) group of companies. GlaxoSmithKline is a research-based pharmaceutical and healthcare company committed to improving the quality of human life by enabling people to do more, feel better and live longer. For a copy of the executive summary of Confronting COPD in North America and Europe: A Survey of Patients and Doctors in Eight Countries or Confronting COPD in America conducted by Schulman, Ronca, and Bucuvalas, Inc., 2001, please contact Robin Gaitens at +1 919 483 2839. The US survey findings will be available in October 2001 at http://www.COPDinAmerica.org . 1. Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020:Global Burden of Disease Study. Lancet 1997; 349: 1498-1504. 2. The World Health Report 1998. Life in the 21st century. A vision for all. World Health Organization; Geneva. 1998. 3. National Center for Health Statistics, Report of Final Morbidity Statistics, 1998. Information cited in: American Lung Association, Trends in Chronic Bronchitis and Emphysema: Morbidity and Mortality, December 2000. 4. Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994. Data on file GlaxoSmithKline. 5. Respondents in this category had to report that, for at least two years, they have suffered from persistent (at least three months/year) bronchitis or coughing with phlegm/sputum from the chest. |
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