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      “Breathing New Life Into Chronic Obstructive Pulmonary Disease (COPD)” – Results From An Online Survey Of UK Patients

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          Abstract

          Background

          There is a lack of data on the impact of COPD on individuals, their illness, behavior and attitude to the disease.

          Method

          500 UK patients with a primary care diagnosis of COPD responded to an online survey.

          Results

          61.2% of respondents were female and 85.8% were between 50 and 80 years old. Two-thirds (67.8%) of respondents did not smoke at the time of the survey. Almost half of those surveyed (46.2%, n=231) used three inhalers, and 31% (n=155) agreed or strongly agreed with the statement “I feel that my treatment is not adequately controlling my condition”, while 39.4% (n=197) disagreed or strongly disagreed. 48.8% (n=244) agreed their COPD was well managed. Over half the sample (56.8%, n=284) said they never forgot to use their inhaler as prescribed. Checks on inhaler use by doctors or nurses were reported as every six months/twice a year by 24.4% (n=122) and once a year by 38.8% (n=194). However, 17.2% (n=86) said their technique had never been checked, and at their last annual review, a third (33.2%, n=166) did not receive inhaler technique advice. Exacerbations were reported to affect an average of 7.4 days a year. They led to time in hospital, time off work and significantly affected quality of life. Patients reported that their COPD affected all aspects of their daily lives to a greater or lesser extent, with some living in fear of what the impact of the next flare-up could bring.

          Conclusion

          COPD impairs people’s ability to carry out daily tasks, leads to hospital admission, time off work and even unemployment. Respondents reported stress, worry and depression or low mood because of their COPD. This study highlights areas of concern for patients not being addressed by health care practitioners, including: pulmonary rehabilitation referral, better information giving and medicines optimization.

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          Most cited references 14

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          Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

          Background Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database. Methods This analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ≥35 years of age and with spirometry results supportive of the COPD diagnosis. Results A total of 24,957 patients were analyzed, of whom 13,557 (54.3%) had moderate airflow limitation (GOLD Stage 2 COPD). The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately 50% of patients in both cohorts were receiving inhaled corticosteroids (ICS), either in combination with a long-acting β2-agonist (LABA; 26.7% for both cohorts) or a LABA and a long-acting muscarinic antagonist (LAMA; 23.2% and 19.9%, respectively). ICS + LABA and ICS + LABA + LAMA were the most frequently used treatments in GOLD Groups A and B. Of patients without concomitant asthma, 53.7% of the total COPD population and 50.2% of the GOLD Stage 2 subset were receiving ICS. Of patients with GOLD Stage 2 COPD and no exacerbations in the previous year, 49% were prescribed ICS. A high proportion of GOLD Stage 2 COPD patients were symptomatic on their current management (36.6% with modified Medical Research Council score ≥2; 76.4% with COPD Assessment Test score ≥10). Conclusion COPD is not treated according to GOLD and National Institute for Health and Care Excellence recommendations in the UK primary-care setting. Some patients receive no treatment despite experiencing symptoms. Among those on treatment, most receive ICS irrespective of severity of airflow limitation, asthma diagnosis, and exacerbation history. Many patients on treatment continue to have symptoms.
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            Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study.

            This study was conducted to gain insight into patients' comprehension, recognition, and experience of exacerbations of COPD, and to explore the patient burden associated with these events. A qualitative, multinational, cross-sectional, interview-based study. Patients' homes. Patients (n = 125) with predominantly moderate-to-very severe COPD (age > or = 50 years; with two or more exacerbations during the previous year). Patients underwent a 1-h face-to-face interview with a trained interviewer. During the preceding year, patients experienced a mean +/- SD of 4.6 +/- 5.4 exacerbations, after which 19.2% (n = 24) believed they had not fully recovered. Although commonly used by physicians, only 1.6% (n = 2) of patients understood the term exacerbation, preferring to use simpler terms, such as chest infection (16.0%; n = 20) or crisis (16.0%; n = 20) instead. Approximately two thirds of patients stated that they were aware of when an exacerbation was imminent and, in most cases, patients recounted that symptoms were consistent from one exacerbation to another. Some patients (32.8%; n = 41), however, reported no recognizable warning signs. At the onset of an exacerbation, 32.8% of patients (n = 41) stated that they reacted by self-administering their medication. Some patients spontaneously mentioned a fear of dying (12.0%; n = 15) or suffocating (9.6%; n = 12) during exacerbations, and effects on activities, mood, and personal/family relationships were frequently reported. Physicians tended to underestimate the psychological impact of exacerbations compared with patient reports. This study shows that patients with frequent exacerbations have a poor understanding of the term exacerbation. Patient recollections suggest that exacerbation profiles vary enormously between patients but that symptoms/warning signs are fairly consistent within individuals, and are generally recognizable. Exacerbations appear to have a significant impact on patient well-being, including psychological well-being, and this may be underestimated by physicians.
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              Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme.

              Pulmonary rehabilitation programmes improve the health of patients disabled by lung disease but their cost effectiveness is unproved. We undertook a cost/utility analysis in conjunction with a randomised controlled clinical trial of pulmonary rehabilitation versus standard care. Two hundred patients, mainly with chronic obstructive pulmonary disease, were randomly assigned to either an 18 visit, 6 week rehabilitation programme or standard medical management. The difference between the mean cost of 12 months of care for patients in the rehabilitation and control groups (incremental cost) and the difference between the two groups in quality adjusted life years (QALYs) gained (incremental utility) were determined. The ratio between incremental cost and utility (incremental cost/utility ratio) was calculated. Each rehabilitation programme for up to 20 patients cost pound 12,120. The mean incremental cost of adding rehabilitation to standard care was pound -152 (95% CI -881 to 577) per patient, p=NS. The incremental utility of adding rehabilitation was 0.030 (95% CI 0.002 to 0.058) QALYs per patient, p=0.03. The point estimate of the incremental cost/utility ratio was therefore negative. The bootstrapping technique was used to model the distribution of cost/utility estimates possible from the data. A high likelihood of generating QALYs at negative or relatively low cost was indicated. The probability of the cost per QALY generated being below pound 0 was 0.64. This outpatient pulmonary rehabilitation programme produces cost per QALY ratios within bounds considered to be cost effective and is likely to result in financial benefits to the health service.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                04 December 2019
                2019
                : 14
                : 2799-2807
                Affiliations
                [1 ]M&F Health , London EC1N 8TE, UK
                [2 ]Opinion Health , London W1F 8QA, UK
                [3 ]Nuffield Department of Medicine, University of Oxford , Oxford OX3 7FZ, UK
                Author notes
                Correspondence: Steve Titmarsh M&F Health , 35–37 Kirby Street, LondonEC1N 8TE, UKTel +44 207 492 1793 Email steve.titmarsh@gmail.com
                Article
                222139
                10.2147/COPD.S222139
                6900271
                © 2019 Titmarsh et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 5, Tables: 1, References: 25, Pages: 9
                Funding
                The “Breathing New Life into Chronic Obstructive Pulmonary Disease (COPD)” survey was carried out by the research company, Opinion Health and funded by the pharmaceutical company, Chiesi Limited. The development of this article was also funded by Chiesi Limited.
                Categories
                Original Research

                Respiratory medicine

                optimize, quality of life, exacerbations, inhalers, copd

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