European Respiratory Society's Annual Congress, Berlin
People living with chronic obstructive pulmonary disease (COPD), an umbrella term covering chronic bronchitis and emphysema, may suffer more than they need to because they do not accurately report their symptoms to their doctor. This is according to results of the first international survey of the disease, announced today at the 11th European Respiratory Society's annual congress held in Berlin, Germany.
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 20201. 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, 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. This inability to convey their degree of suffering may partly be caused by the perception that patients believe doctors blame them for their condition due to its association with smoking.”
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%), family activities (34%) and sex life (30%). Additionally, more than one third of patients with COPD (36%) report that their condition keeps them from work, limits their ability to work, or caused them to miss time from work in the past year. Caregivers of patients with COPD may also miss time at work. The total indirect cost of COPD in the USA due to output losses from disability, work and school absence, premature mortality and family costs was estimated at $9.2 billion in 19932. Direct costs from patients suffering with COPD relate to substantial primary and secondary healthcare expenditure. For example, in the USA in 1995, the hospitalization cost of managing chronic bronchitis was almost 40 times higher ($1,592 million) than the out-patient cost of just under $40 million3.
The results also revealed that COPD is not simply a disease of the elderly male as it is often portrayed. The majority (54%) of patients interviewed In the eight nations is under 65 years of age. The distribution between genders was fairly evenly split between men (56%) and women (44%), with women representing the majority in the United States (55%), Canada (51%) and the United Kingdom (51%).
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. Furthermore, thirteen percent of patients were hospitalized for their condition in the past year and a further 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.”
Chronic obstructive pulmonary disease (COPD) is currently the fifth most common disease and the fourth cause of death in the world4. The common characteristics are limited airflow into the lungs and the detrimental changes in the lung tissue that cannot be fully reversed.
This survey was conducted by market research company Schulman, Ronca and Bucuvalas, Inc. and funded by GlaxoSmithKline. Interviews were completed with 3,265 COPD patients in the United States, Canada, France, Germany, Italy, The Netherlands, Spain and the United Kingdom. Nine-hundred and five doctors were also interviewed.
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 additional information or the Executive Summary of Confronting CCPD in North America and Europe: A Survey of Patients and Doctors in Eight Countries conducted by Schulman, Ronca and Bucuvalas, Inc. 2001, please contact:
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1Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349: 1498-1504.
2Buist SA. The economic burden or COPD. In: The impact of COPD: standards for assessing long-term efficacy in COPD. Satellite Symposia to the 1999 European Respiratory Society Congress, Madrid 10-11 October 1999.
3Niederman MS, McCombs JS, Unger AN et al. Treatment cost of acute exacerbations of chronic bronchitis. Clin Therap 1999; 21(3): 576-91.
4The World Health Report 1998. Life in the 21st Century. A vision for all. World Health Organization, Geneva 1998.