Clinical research study
Comorbidities, Patient Knowledge, and Disease Management in a National Sample of Patients with COPD

https://doi.org/10.1016/j.amjmed.2008.09.042Get rights and content

Abstract

Objective

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States but is often undertreated. COPD often overlaps with other conditions such as hypertension and osteoporosis, which are less morbid but may be treated more aggressively. We evaluated the prevalence of these comorbid conditions and compared testing, patient knowledge, and management in a national sample of patients with COPD.

Methods

A survey was administered by telephone in 2006 to 1003 patients with COPD to evaluate the prevalence of comorbid conditions, diagnostic testing, knowledge, and management using standardized instruments. The completion rate was 87%.

Results

Among 1003 patients with COPD, 61% reported moderate or severe dyspnea and 41% reported a prior hospitalization for COPD. The most prevalent comorbid diagnoses were hypertension (55%), hypercholesterolemia (52%), depression (37%), cataracts (31%), and osteoporosis (28%). Only 10% of respondents knew their forced expiratory volume in 1 second (95% confidence interval [CI], 8-12) compared with 79% who knew their blood pressure (95% CI, 76-83). Seventy-two percent (95% CI, 69-75) reported taking any medication for COPD, usually a short-acting bronchodilator, whereas 87% (95% CI, 84-90) of patients with COPD and hypertension were taking an antihypertensive medication and 72% (95% CI, 68-75) of patients with COPD and hypercholesterolemia were taking a statin.

Conclusion

Although most patients with COPD in this national sample were symptomatic and many had been hospitalized for COPD, COPD self-knowledge was low and COPD was undertreated compared with generally asymptomatic, less morbid conditions such as hypertension.

Section snippets

Materials and Methods

Participants were drawn from a national sample of 4003 households in which 1 or more persons reported a diagnosis of a form of COPD. COPD was ascertained by the questionnaire item, “Have you ever been diagnosed by a physician as having: emphysema; chronic obstructive pulmonary disease (COPD); [or] alpha-one antitrypsin deficiency?” Patients with COPD with a co-diagnosis of asthma were not excluded because of the overlap of these 2 conditions in clinical practice. The sampling frame was derived

Results

The characteristics of the 1003 patients who responded to the survey, stratified by gender, are shown in Table 1. The mean age (± standard deviation) was 61 ± 10 years, and 58% were women. Respondents lived mostly in the Midwest and the South of the United States and were predominantly white. Half had no education beyond high school. Ninety-five percent noted a history of daily cigarette use, and 47% of women and 39% of men smoked cigarettes regularly at the time of the survey. A co-diagnosis

Discussion

This national survey of patients with diagnosed COPD suggested that comorbid diagnoses of hypertension, hypercholesterolemia, depression, and osteoporosis occur frequently in patients with COPD. Although this was a COPD survey and despite similar amounts of clinical testing, patients' knowledge of their cholesterol levels and blood pressure far exceeded their knowledge of their FEV1. COPD was undertreated compared with other conditions, such as hypertension, which is generally asymptomatic and

Conclusions

Comorbidities are common in COPD and likely add to the complexity and cost of care. Although patients with COPD take a large number of medications, relatively few of these medications are for COPD. This discrepancy may relate to poor physician and patient knowledge about COPD26 or reflect the more limited evidence base for COPD compared with other leading causes of death. Although advances in COPD pathophysiology and clinical research are needed to have a full impact, better education and

Acknowledgments

We thank the COPD Foundation, which commissioned the survey, and the firm of Schulman, Ronca and Bucuvalas, Inc, which administered the survey, performed initial data analyses, and assisted with some aspects of the initial manuscript preparation.

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      In a study of 1,003 patients with COPD, nearly half had five or more comorbid conditions [5]. The most common conditions included hypertension (55%) and hypercholesterolemia (52%) [5]. However, many studies in this population focused on an isolated health-related behavior and did not take patients’ other illnesses into account.

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    Funding: The COPD Foundation and National Institutes of Health HL077612 and HL075476.

    Conflict of Interest: R. Graham Barr, MD, DrPH: none. Bartolome R. Celli, MD: research grants from Glaxo Smith Kline (GSK), Boehringer Ingelheim (BI), Forrest Medical, Astra Zeneca; advisory board payments from GSK, BI, Almirall, Astra Zeneca; speakers' fees from GSK, BI, Astra Zeneca, Almirall. David Mannino, MD: research funding from GSK, Pfizer, and Novartis; consultant or speakers' fees from GSK, Pfizer, BI, Astra-Zeneca, Dey, and Sepracor. Thomas Petty, MD: none. Stephen I. Rennard, MD: research grants from Almirall, Lorillard, Centocor, Novartis, GSK, Philip Morris, Institute for Science and Health, Roche; consultancy and advisory board payments from Abbott, Johnson & Johnson, Almirall, Novartis, Altana, Roche, Anthera, Quintiles, GSK, Targegen; speakers' fees from Adams, Novartis, AstraZeneca, Pfizer. Frank C. Sciurba, MD: consultancy for Astra Zeneca, BI, Dey, GSK, Novartis, Pfizer, PneumRX, Respironics, Schering and Sepracor. James K. Stoller, MD, MS: consultancy for Talecris Biotherapeutics, BI; speaker for Grifols, Baxter, CSL-Behring, Pfizer, Talecris. Byron M. Thomashow, MD: speakers' fees and consultancy for BI, Pfizer and GSK. Gerard M. Turino, MD: research grant from BI; consultancy for Talecris Corporation.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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