Chest
Volume 130, Issue 1, July 2006, Pages 133-142
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Original Research
Patient Understanding, Detection, and Experience of COPD Exacerbations: An Observational, Interview-Based Study

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Study objectives

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.

Design

A qualitative, multinational, cross-sectional, interview-based study.

Setting

Patients’ homes.

Patients

Patients (n = 125) with predominantly moderate-to-very severe COPD (age ≥ 50 years; with two or more exacerbations during the previous year).

Interventions

Patients underwent a 1-h face-to-face interview with a trained interviewer.

Measurements and results

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.

Conclusions

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.

Section snippets

Materials and Methods

This was a cross-sectional study conducted in France, Germany, Spain, Sweden, and the United Kingdom involving men and women aged ≥ 50 years with a diagnosis of COPD (according to the Global Initiative for Chronic Obstructive Lung Disease guidelines1). Patients were recruited prospectively by 7 general practitioners and 23 respiratory physicians during normal clinic visits by convenience sampling. During this visit, physicians discussed the study with their patients and, after assessing their

Analysis

The aim was to recruit 125 patients (25 patients per country) according to the specific inclusion and exclusion criteria. It was predefined that 50% of patients should be aged 50 to 65 years, and 50 to 75% of patients completing the interview should be men.

The face-to-face interviews were transcribed verbatim and their thematic content analyzed. To give some indication of concerns, patients were asked to assess their worries about exacerbations using a linear, subjective visual analog scale

Baseline Demographics and Disease Characteristics

A total of 125 patients (mean age, 66.4 ± 8.5 years; 65.5% men) were recruited from France (n = 25), Germany (n = 25), Spain (n = 27), Sweden (n = 28), and the United Kingdom (n = 20). Baseline disease and demographic characteristics are shown in Table 1.

The majority of patients had comorbid conditions (77.6%; n = 97), most commonly cardiovascular disease (38.4%; n = 48), endocrine disorders (16.0%; n = 20), and rheumatic disease (15.2%; n = 19). Of the 104 patients (83.2%) who underwent Global

Discussion

It is established that exacerbations have a dramatic impact on disease progression, morbidity, mortality, and HRQL in patients with COPD.2 However, patients’ understanding and experience of exacerbations, and the impact of these events from their perspective, have until now remained largely unexplored. The results of this multinational, cross-sectional study of patient perceptions of their experience of COPD exacerbations reveal interesting findings that may be used to guide clinical practice

Acknowledgment

This study was devised by the authors and undertaken by Mapi Values, Lyon, France, with the support of AstraZeneca R&D, Lund, Sweden. Interpretation and evaluation of the results were by all of the authors, and Mark Richardson of Adelphi Communications Ltd, Macclesfield, UK, provided medical writing support.

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