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Clinical Burden of COPD

 

COPD is associated with persistent respiratory symptoms, exacerbations, and inflammation, which contribute to declines in lung function, reduced QOL, and high mortality.

Symptom burden

Physical

Persistent symptoms of COPD contribute to patients’ physical debilitation1.

In 2017, COPD was the sixth leading cause of disability-adjusted life years (DALYs) worldwide and accounted for the majority of DALYs associated with chronic respiratory disease2,3

I am continually tired. The simplest tasks take ages to complete and leave me exhausted, breathless, and depressed.

Not being able to breathe and unable to do physical activity. The worst part: Your mind tells you that you can do it.

Not being able to breathe and unable to do physical activity. The worst part: Your mind tells you that you can do it.

Mental

ASSESS was an observational study which enrolled patients with stable COPD in clinical practice and aimed to investigate the relationship between 24-hour symptoms and other patient-reported outcomes4.

Persistent symptoms of COPD were associated with high levels of anxiety and depression, and poor sleep quality, irrespective of whether symptoms occurred in the early morning, daytime, or night time4.

Patients who experienced symptoms throughout the whole 24-hour day experienced the worst levels of impairment4.

Mean anxiety, depression, and sleep quality scores according to the pattern of COPD symptoms throughout the 24 hour day (n=727)4

Anxiety Depression Sleep Disturbance

*0-7 = normal; 8-10 = mild; 11-15 = moderate; 16-21 = severe. Higher scores mean worse sleep quality.,
CASIS, COPD and Asthma Sleep Impact Scale; HADS, Hospital Anxiety and Depression Scale.

Quality of Life

Persistent debilitating symptoms of COPD have a substantial impact on patients' QoL.

A cross-sectional European observational study illustrated QoL impairment was related to COPD severity:

As disease severity increased, QoL impairment increased, as measured using SGRQ scoress5.

Factors associated with worsening QoL include5:

  • COPD symptoms of breathlessness

  • Cough and excess sputum

  • Exacerbations

  • Lung function decline

  • Hospitalizations

Impairment in QoL related to COPD severity:Data from a cross-sectional European studys5

In many patients, guilt or shame from their perception of COPD as a "self-inflicted" disease can effect their QoL and interaction with HCPs1.
 

The MIRROR study was conducted in Europe and analysed how perceptions of disease severity and impact on QOL may differ between patients and HCPs. This study found that6:
 

  • ~90% of patients said they were "not completely frank" when talking to clinicians
     
  • 49-53% of primary care doctors and pulmonologists seem to be aware of this but underestimate the extent to which it impacts clinician-patient interactions1

 

Clinical burden of co-existing conditions in COPD

The inflammatory processes associated with COPD may affect the functioning of extrapulmonary systems, and as a result, COPD patients present with co-existing diseases across a range of organ systems16. This can greatly increase the burden of COPD.

In a retrospective analysis of 14,603 Dutch patients with COPD, 88% had ≥1 co-existing disease16

*The consideration of asthma as a separate co-existing disease from COPD is controversial.

CRS, chronic rhinosinusitis; AF, atrial fibrilation; CHD, coronary heart disease; GERD, gastroesophageal reflux disease; PVD, peripheral vascular disease; TIA, transient ischemic attack.

COPD with co-existing conditions is associated with negative health impact, worse treatment management:


Health Impact
 

  • Patients with COPD and co-existing diseases, such as heart failure, osteoporosis/osteopenia, and asthma have an increased risk of frequent exacerbations16
     
  • COPD and co-existing Asthma also result in increased hospital admissions, whereas COPD and cardiovascular disease has a higher rate of hospitalization and death17,18


Worse treatment management
 

  • 30% of patients with COPD and Asthma have ≥2 records of OCS dispensing over their lifetime vs. 12% of patients with COPD alone19
     
  • Short- and long-term OCS use has been linked to multiple adverse-events20
     

Exacerbations

Patients with COPD can experience "flare-ups"" which can be defined as general worsening of symptoms as well as more serious exacerbations.

An exacerbation of COPD is defined as an event characterized by increased dyspnea and/or cough and sputum that worsens in <14 days which may be accompanied by tachypnea and/or tachycardia and is often associated with increased local and systemic inflammation caused by infection, pollution, or other insult to the airways21,31.

Exacerbations can be mild, moderate and severe. Severe exacerbations usually require hospitalisation22.

Exacerbations of COPD significantly impact on the health status of a patient, increase the rate of lung function decline, and worsen the prognosis of patients.

Quality of life

In a study of 70 COPD patients, SGRQ total and component scores — a tool used to measure quality of life-were significantly higher in the frequent exacerbator group compared with those who less frequently experienced exacerbations23.

Relationship between SGRQ score and exacerbation frequency23

Exacerbation frequency n SGRQ total score SGRQ
component: Symptoms		 SGRQ
component: Activities		 SGRQ
component: Impact
0-2 32 48.9 ± 15.6 53.2 ± 17.2 67.7 ± 17.2 36.3 ± 18.2
3-8 38 64.1 $ 14.6 77.0 $ 15.8 80.9 $ 16.0 50.4 ‡ 17.6
Mean difference   -15.1 -21.9 -12.2 -14.1
95% CI   -22.3 to -7.8 -29.7 to -14.0 -21.2 to -5.3 -22.9 to -5.6
P value   0.0005 0.0005 0.001 0.002

Mortality

In a study of 73,106 COPD patients, the risk of death increased with each successive severe exacerbation experienced.

The rate of death after the second severe exacerbation was 1.9x higher than after the first, while after the 10th it was 5x higher than after the first.

HR for death increases with every successive severe exacerbation24

Lung function

The UPLIFT study of 5,992 COPD patients observed that a higher frequency of severe hospitalized COPD exacerbations was associated with a marked decline in lung functions25.

Mean change in lung function parameters by increasing frequency of hospitalized exacerbations in the 4-year UPLIFT study25

Exacerbations were defined as an increase in or the onset of more than one respiratory symptom (cough, sputum, sputum purulence, wheezing, or dyspnea) lasting 3 days or more and requiring treatment with an antibiotic or systemic corticosteroids.

BD, bronchodilator; FVC, forced vital capacity; SE, standard error.

Disease onset, course, and severity

COPD can start early in life and take a long time to manifest clinically. As identifying early COPD can be difficult, patients are typically diagnosed with COPD aged > 40 years 31,32.

Morbidity due to COPD increases with age:
As lung function declines with age, patients experience more exacerbations, which increases the risk of future exacerbations and the rate of lung function decline31.

Dupixent API

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