<AsiaNet> Doctors Tend to Underestimate the Emotional Impact of COPD

Exacerbations - Patients Fear Being Hospitalised or Dying

(LUND, Sweden, July 13 AsiaNet=연합뉴스)

- New Patient Data in COPD Brings Valuable Insight to the Consequences of

Exacerbations on Patients' Lives, Demonstrating a Strong Psychological

Impairment -

New data from a multinational, interview-based patient study, published

today in the medical journal CHEST, shed light on COPD patients' comprehension,

recognition, and experience of exacerbations and the burden associated with

these events(1).

Exacerbations are known to impair health-related quality of life (HRQL) in

patients with COPD and increase the risk of mortality(2). Today's paper also

brings valuable insight into the burden of exacerbations as experienced by

patients. The study shows that physicians often underestimate the

psychological impairment experienced by patients during an exacerbation.

Exacerbations cause substantial anxiety, patients reported; 12% stated they

worry about dying, 10% that they worry about suffocating, 10% that they will

experience a permanent worsening of their condition and 8% that they will be

hospitalised. A majority of patients reported that besides influencing their

activities in daily life, a worsening of symptoms significantly affects their

mood causing a variety of negative feelings, such as depression,

irritability/bad temper, anxiety, isolation, anger, and guilt. Moreover 42%

stated that exacerbations affected their personal relationships.

"The observation that physicians fail to appreciate the considerable

changes to the patient's emotional wellbeing demonstrates a communications gap

between patients and their doctors and represents a dilemma in the management

of COPD. Such underestimation of the burden of exacerbations may contribute to

under treatment of COPD by healthcare professionals. This is worrying since

the existing evidence shows that early medical intervention improves recovery

time, minimises the risk of hospitalisation and improves health-related

quality of life(3). A clear link between increased exacerbation frequency and

risk of mortality has also been demonstrated(4)" explained study lead-

investigator, Professor Romain Kessler, Department of Pulmonology, Hopitaux

Universitaires de Strasbourg in France.

The study was conducted among 125 patients diagnosed with COPD from

France, Germany, Spain, Sweden and the UK. The patients were aged greater than

or equal to 50 and had experienced a minimum of 2 exacerbations during the

previous year. 65% were male COPD patients. During the previous 12 months,

patients had experienced a mean of 4.6 exacerbations with an average duration

of 2 weeks and a mean recovery time of 10 days. Notably, 20% felt that they

had not returned to their previous state of health after an exacerbation,

demonstrating the importance of reducing these events.

The importance of improving patients' health-related quality of life

(HRQL) was further supported by data from a pooled analysis of two

multinational randomised controlled clinical trials recently presented at the

COPD5 congress in Birmingham, UK(5, 6). The analysis showed that HRQL was the

strongest predictor of mortality in COPD(5) and that the addition of

budesonide to formoterol (Symbicort(R)) and/or a short-acting bronchodilator

reduced the risk of mortality compared to bronchodilators alone(6).

Another interesting finding supporting the observed communications gap

between healthcare professionals and patients is that, although a term

commonly used by physicians, only 1.6% of patients understood what was meant

by the widely used clinical term 'exacerbations' (in the study defined as a

worsening of respiratory symptoms such that bronchodilators, and/or oral

corticosteroids, and/or antibiotics, and/or oxygen therapy, and/or

hospitalisation were required). Instead, patients used simpler, easier to

understand terms to describe a worsening of their condition. The single term

used most often by patients to describe an exacerbation is 'crisis',

underscoring the seriousness with which patients view the worsening of their

condition.

Two-thirds of patients stated they are aware of the symptoms associated

with their condition getting worse, recognising them as warning signs. Most

patients (85%) experience the same symptoms from one exacerbation to another -

'breathlessness' being the most commonly recollected warning sign. At the

onset of an exacerbation, 33% of patients reported that they react by self-

administering their medication while only a minority contacts their

physician.

"The observation that two-thirds of patients are easily able to identify

consistent warning signs is new and important. The finding suggests a window

of opportunity for intervening and preventing a full-blown deterioration. The

fact that patients show a willingness to undertake self-medication moreover

suggests a potential role for self-management based on individual action

plans," concluded Professor Kessler.

References:

1. Kessler R, Stahl E, Vogelmeier C, Haughney J, Trudeau E, Lofdahl C-G,

and Partridge M R. Patient Understanding, Detection, and Experience

of COPD Exacerbations: An Observational, Interview-Based Study.

Chest 2006;130 133-142.

http://www.chestjournal.org/cgi/content/abstract/130/1/133

2. Calverley PM, Boonsawat Z, Zhong N, Peterson S and Olsson H.

Maintenance therapy with budesonide and formoterol in chronic

obstructive pulmonary disease. Eur Resp J 2003; 22; 912-919.

3. Wilkinson TM, Donaldson GC, Hurst JR, et al. Early therapy improves

outcomes of exacerbations of chronic obstructive pulmonary disease.

Am J Respir Crit Care Med 2004; 169:1298-1303.

4. Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P, Salcedo E,

Navarro M, Ochando R. Severe acute exacerbations and mortality in

patients with chronic obstructive pulmonary disease. Thorax

2005;60:925-31.

5. Jones P, Calverley P, Larsson T, Peterson S. St George's Respiratory

Questionnaire (SGRQ) scores may help identify COPD patients at

increased risk of death over 1 year. Presentation at COPD5,

Birmingham, UK, 28 June 2006, Abstract 34.

6. Calverley P, Jones P, Larsson T, Peterson S. Preventing mortality in

COPD: The value of inhaled budesonide added to bronchodilators.

Presentation at COPD5, Birmingham, UK, 28 June 2006, Abstract 35.

The study was conducted with the support of AstraZeneca R&D, Lund, Sweden.

AstraZeneca is the manufacturer of Symbicort(R), a combination of the

inhaled corticosteroid budesonide and rapid- and long-acting beta-agonist

formoterol, which is indicated for the treatment of asthma and COPD.

SOURCE AstraZeneca

CONTACT: Anette Orheim of AstraZeneca, Office: +46-46-33-80-87, or

Mobile: +46-709-13-19-52 ; or Mette Thorn Sorensen of Cohn & Wolfe, for

AstraZeneca, Office: +45-33-13-13-20, or Mobile: +45-41-38-43-00

anet@yna.co.kr

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