CME: The Burden of COPD & Symptom Severity

CME: The Burden of COPD & Symptom Severity
Author Information (click to view)

MeiLan K. Han, MD, MS

Associate Professor, Division of Pulmonary & Critical Care Medicine
Department of Internal Medicine
Medical Director, Women’s Respiratory Health Program
University of Michigan Health System

MeiLan K. Han, has indicated to Physician’s Weekly that she has worked as a consultant for GlaxoSmithKline, Boehringer Ingelheim, and Regeneron Pharmaceuticals.

Figure 2 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

  1. Explain the findings of the Continuing to Confront COPD Patient Survey.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at

Credit Available(click to view)


CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.


AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Christopher Cole – Senior Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
MeiLan K. Han, MD, MS
Dr. Han has disclosed the following relevant financial relationships:
Consultant:  BI, GlaxoSmithKline, Regeneron Pharmaceuticals Inc., Novartis Pharmaceuticals Corp.

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.


MeiLan K. Han, MD, MS (click to view)

MeiLan K. Han, MD, MS

Associate Professor, Division of Pulmonary & Critical Care Medicine
Department of Internal Medicine
Medical Director, Women’s Respiratory Health Program
University of Michigan Health System

MeiLan K. Han, has indicated to Physician’s Weekly that she has worked as a consultant for GlaxoSmithKline, Boehringer Ingelheim, and Regeneron Pharmaceuticals.

Survey results indicate that there appears to be a disconnect between the perceptions of disease severity among patients with COPD and the reality of how well the disease is being managed. Findings highlight the importance of patient education and objective symptom assessment.
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In 2000, the first “Confronting COPD International Survey” found that many patients with diagnosed COPD or symptoms consistent with chronic bronchitis underestimated their symptoms and severity of disease in North America and Europe. To obtain a current estimate of COPD prevalence and disease burden from patients’ and physicians’ perspectives, MeiLan K. Han, MD, MS, and colleagues conducted the follow-up “Continuing to Confront COPD Patient Survey” in 2013. Findings were published in the International Journal of Chronic Obstructive Pulmonary Disease.

“There are important cultural and ethnic influences as well as country-specific differences in health systems that can influence patient’s treatment and perception of their care,” says Dr. Han. “Our survey highlights how COPD care in the United States compares with countries around the world and may provide insights on how to approach specific groups of patients, given that the U.S. is a multicultural country.”

Uncovering a Disconnect

After identifying patients with COPD in 12 countries—Brazil, France, Germany, Italy, Japan, Mexico, Netherlands, Russia, South Korea, Spain, Great Britain, and the U.S.— through several methods, Dr. Han and colleagues conducted surveys via telephone, the internet, and face-to-face meetings, depending on the unique challenges in each country.

“The most important finding from our survey is that there appears to be a significant disconnect between how patients with COPD perceive their disease severity and the actual symptoms they experience,” says Dr. Han (Figure). “In the U.S., 29% of patients reported that their disease was mild, 41% thought it was moderate, 24% stated it was severe, and 5% said that their disease was very severe. However, nearly 55% had to use a rescue medication every day or most days. In addition, 44% woke up every night or most nights due to symptoms. The average COPD Assessment Test (CAT) score was 23.3, which is high considering that a score on the CAT higher than 10.0 is considered significantly symptomatic.”

The research team also found that 26% of participants reported at least one COPD-related emergency room visit in the previous 12 months, with 17% having been admitted to the hospital due to a COPD-related issue. “The finding that one-quarter of patients had a major health resource utilitzation event highlights the burden of the disease” adds Dr. Han.

Dr. Han speculates that the study team’s observed disconnect may be due in part to patients becoming acclimated to the severity of their COPD symptoms. Patients may also significantly alter their lifestyle to avoid activities that make them short of breath. “This finding illustrates the importance of going beyond simply asking patients if they’re short of breath,” says Dr. Han. “Clinicians need to ask patients about cough and sputum production and activity limitations. They also should conduct objective assessments using tools like the CAT questionnaire. Better patient education on the signs and symptoms of COPD and COPD exacerbations is crucial.”

A Look at Prevalence

The finding of an overall estimated COPD prevalence of about 7% is close to what has been observed in other studies reporting on the global prevalence of the disease. The estimated COPD prevalence was higher in men when compared with women in the U.S., as it was in most countries (Table), and there was a steady increase with age:

♦ Overall            6.7%
♦ Men                 6.2%
♦ Women           7.1%
♦ Aged 40-49    3.9%
♦ Aged 50-59     6.4%
♦ Aged 60-69    6.7%
♦ Aged 70+        8.9%

The gender differences were consistent with a higher prevalence of current smokers reported among men. Although the majority of participants were former or current smokers, nearly 25% reported that they had never smoked. Half of never-smokers reported environmental exposure, such as dust or fumes in the home or workplace.

Implementing the Findings

“Most pulmonologists understand the importance of performing spirometry to diagnose or rule out COPD,” says Dr. Han. “Our findings, however, emphasize the importance of realizing that COPD causes a high societal and personal burden, as demonstrated by high levels of symptoms, poor health status, and a high frequency of severe exacerbations of COPD. It also highlights the fact that the substantial burden of COPD is discordant with the perceptions of disease severity among patients.”

Dr. Han recommends that clinicians recognize that it is important to not only ask about symptoms, but to understand how those symptoms might be impacting quality of life. “By obtaining a good history of exacerbations and thoroughly assessing disease burden, we can make progress on improving how COPD is managed.”

Readings & Resources (click to view)

Landis S, Muellerova H, Mannino D, et al. Continuing to confront COPD international patient survey: methods, COPD prevalence, and disease burden in 2012–2013. Int J Chron Obstruct Pulmon Dis. 2014; 9:597-611. Available at:–peer-reviewed-article-COPD.

Bestall J, Paul E, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54:581-586.

Jones P, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34:648-654.

Hibbard J, Mahoney E, Stockard J, Tusler M. Development and testing of a short form of the Patient Activation Measure. Health Serv Res. 2005;40:6.

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