A cross-sectional assessment of the burden of COPD symptoms in the US and Europe using the National Health and Wellness Survey

Abstract

IntroductionPast research has suggested significant relationships between symptoms and health outcomes among patients with COPD. However, these studies have generally focused on a broad COPD sample and may have included those not receiving proper treatment. As a result, the aim of this study was to document the burden of COPD symptoms among those who are currently treated with the standard-of-care (SOC) medications in both the US and Western Europe.MethodsData from the 2013 US (N=75,000) and 2011 (N=57,512)/2013 (N=62,000) European (France, Germany, Italy, Spain, and UK; 5EU) National Health and Wellness Survey (NHWS) were used. The NHWS is a health survey administered to a demographically representative sample of the adult population in each country. A total of 1,666 and 2,006 patients with self-reported physician diagnosis of COPD in the 5EU and US, respectively, were being treated with the appropriate SOC (based on self-reported medication use) and were included in the analyses. Symptoms (eg, dyspnea, coughing, wheezing) were reported descriptively and summed to create a symptom score (with higher score indicating more frequent symptoms). The relationships between the symptom score and patient outcomes (eg, health status using the Short Form-36 version 2 [SF-36v2], work productivity and activity impairment [WPAI], and self-reported health care resource use) were explored using regression modeling.ResultsNearly all patients (99.7% and 99.8% in the 5EU and US, respectively) reported experiencing symptoms and >80% reported experiencing at least one symptom “often”. Increasing symptom scores were associated with poorer health status (unstandardized beta [b] =−0.87 and −0.78 for mental component summary and physical component summary, respectively, in the US and b =−0.67 and −0.79 in the 5EU, respectively; all P<0.05). Increasing symptom scores were also associated with greater work impairment (b =0.09 and 0.06 for the US and 5EU, respectively), activity impairment (b =0.05 and 0.06, respectively), and health care resource utilization (eg, hospitalizations: b =0.05 and 0.06, respectively) (all P<0.05). Approximately 70% of patients reported some level of non-adherence. Greater non-adherence was significantly associated with more frequent symptoms, poorer health status, and greater work impairment and health care resource use (all P<0.05).ConclusionPatients with COPD who are using the appropriate SOC still experience symptoms, which have a significant effect on both humanistic and economic outcomes.

Alteration of the irisin&ndash;brain-derived neurotrophic factor axis contributes to disturbance of mood in COPD patients

“…Furthermore, our findings have a possible practical implication as the efficacy of disease management programs has been shown to depend greatly on the patients’ ability to utilize personal resources like motivation to alter behavior and willingness to set new goals 61. Nonadherence to standard care is very frequent among COPD patients reaching ~70% 3. Considering these aspects, a further consequence of altered irisin–BDNF axis (and downstream processes including mesocortico-limbic dysfunction) may be the impairment of reward-related motivation, preventing change of behavior needed for COPD management and causing lack of efficacy of disease management programs.…”

“…COPD primarily worsens quality of life by developing chronic, progressive dyspnea and consequent limitation of physical activity 3. Moreover, co-existing mental health problems show higher prevalence in COPD patients than in the general population,2,4 with depression and anxiety being present in ~20%–40% and 30%–50% of COPD cases, respectively 2,4–7.…”

Self-rated health aspects among persons living with chronic obstructive pulmonary disease

“…This cohort was small (n=116), the respondents represented a limited geographical area, and the response rate was low, at 29%, a challenge experienced also in other studies on persons living with COPD 55. No data were available regarding noncompliance, and therefore why so few persons participated was not explainable.…”

24-h bronchodilation and inspiratory capacity improvements with glycopyrrolate/formoterol fumarate via co-suspension delivery technology in COPD

“…High-quality evidence from multiple clinical trials suggests that combination treatment with a long-acting muscarinic antagonist (LAMA) and a long-acting β 2 -agonist (LABA) reduces symptoms compared to LAMA or LABA monotherapy [ 2 ]. COPD symptoms tend to vary throughout the day [ 3 – 5 ], and despite treatment, many patients with COPD experience symptoms throughout the whole 24-h day, including night-time and early morning symptoms [ 6 , 7 ]. Patients who experience symptoms during any part of the 24-h day have significantly worse outcomes across patient-reported measures (including health status, sleep quality, anxiety, and depression) compared with asymptomatic patients [ 7 ], highlighting the need for therapeutic approaches that provide 24-h symptom control.…”