Highlights
- •The patient's needs are highly relevant for the choice of therapy and the level of adherence.
- •This survey explores the role of the patient's personal outcome (PPO) in the care of patients with COPD.
- •Patients prioritized improvement of breathlessness during physical activities.
- •PPOs are only partly satisfied by current treatment.
- •Appropriate assessment of PPOs could lead to better management of COPD.
Abstract
Background
Patient's expectations and needs may influence adherence in chronic obstructive pulmonary
disease (COPD). The objectives of this survey were to assess the specific outcomes
that patients expected their COPD treatment to improve (patient's personal outcome
[PPO]) and to evaluate how the ongoing therapy was able to reach this objective.
Methods
We performed an exploratory pragmatic survey of COPD patients attending 2 university
hospitals for scheduled follow-up visits. Patients had to indicate their PPO, the
effect of ongoing treatment on the PPO, the symptom COPD of they expected treatment
to improve and how this symptom is currently bothering them. Patients also underwent
assessment of lung function and completed the COPD assessment test (CAT).
Results
We analyzed data from 144 consecutive patients, (62.5% males; age range 54–94; mean
age 73.88 ± 8.33). A total of 23 different PPOs were scored, and 44.5% of patients reported an
improvement ≥6 (mean 4.93 ± 2.27 on a 0–10 points scale) due to ongoing treatment. The correlation between perceived
improvement in PPO and CAT score was weak and negative (r = −0.13, p = 0.11), whereas it was high and significant with FEV1 (r = .35, p = 0.007). The clinical features patients most expected their ongoing treatment to improve
were breathlessness (64.6% of patients), cough (13.9%), sputum production (11%) and
episodes of exacerbation (8.3%), for which their scores were, respectively, 7.12 ± 1.99, 6.8 ± 2.24, 6.63 ± 2.13, and 8.0 ± 0.94.
Conclusion
Appropriate assessment of PPO could lead to better long-term management of COPD.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease.(Available from:) ([Accessed July 2, 2015])Date: 2015
- Characterisation of COPD heterogeneity in the ECLIPSE cohort.Respir Res. 2010; 11: 122
- Cluster analysis in the COPDGene study identifies subtypes of smokers with distinct patterns of airway disease and emphysema.Thorax. 2014; 69: 415-422
- Phenotypic and genetic heterogeneity among subjects with mild airflow obstruction in COPDGene.Respir Med. 2014; 108: 1469-1480
- Low use and adherence to maintenance medication in chronic obstructive pulmonary disease in the general population.J Gen Intern Med. 2015; 30: 51-59
- Doctor–patient relationship: a resource to improve respiratory diseases management.Eur J Intern Med. 2012; 23: 442-446
- Why do doctors and patients not follow guidelines?.Curr Opin Allergy Clin Immunol. 2009; 9: 228-233
- Development and first validation of the COPD Assessment Test.Eur Respir J. 2009; 34: 648-654
- How representative are clinical study patients with asthma or COPD for a larger “real life” population of patients with obstructive lung disease?.Respir Med. 2005; 99: 11-19
- Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.PLoS One. 2014; 9e90145
- Impact of patients' satisfaction with their inhalers on treatment compliance and health status in COPD.Respir Med. 2014 Feb; 108: 358-365
- Long-acting bronchodilators improve health related quality of life in patients with COPD.Respir Med. 2013; 107: 1465-1480
- Bronchodilator responsiveness in patients with COPD.Eur Respir J. 2008; 31: 742-750
- Minimum clinically important difference for the COPD Assessment Test: a prospective analysis.Lancet Respir Med. 2014; 2: 195-203
- Effects of indacaterol versus tiotropium on respiratory mechanics assessed by the forced oscillation technique in patients with chronic obstructive pulmonary disease.Int J Chron Obstruct Pulmon Dis. 2015; 10: 1139-1146
- Early impact of treatment with tiotropium, long-acting anticholinergic preparation, in patients with COPD — real-life experience from an observational study.Int J Chron Obstruct Pulmon Dis. 2015 Mar 18; 10: 613-623
- Influence of indacaterol on daily physical activity in patients with untreated chronic obstructive pulmonary disease.Int J Chron Obstruct Pulmon Dis. 2015; 10: 439-444
- Indacaterol and tiotropium combination therapy in patients with chronic obstructive pulmonary disease.Pulm Pharmacol Ther. 2015; 30: 11-15
- COPD assessment test: a simple tool to evaluate disease severity and response to treatment.COPD. 2014; 11: 489-495
- Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE).Eur Respir J. 2008; 31: 869-873
- Nominal, ordinal, interval and ratio typologies are misleading.Am Stat. 1994; 48: 61-62
- Measuring health: a guide to rating scales and questionnaires.Oxford University Press, New York1996
- Measurement of quality of life II. From the philosophy of life to science.Scientific World Journal. 2003; 3: 962-971
Article info
Publication history
Published online: June 17, 2016
Accepted:
May 31,
2016
Received in revised form:
May 27,
2016
Received:
March 3,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
