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.”