Continuing to Confront COPD International Surveys: comparison of patient and physician perceptions about COPD risk and management

Figures & data

Table 1 Physician beliefs and knowledge about COPD prognosis and treatment: Continuing to Confront COPD International Survey, 2012–2013

Question	Response (%)
	Strongly agree	Somewhat agree	Somewhat disagree	Strongly disagree
No current treatments reduce mortality or halt COPD progression	16	30	34	18
Inflammation is a key component of COPD and should be treated	58	34	5	1
More frequent exacerbations are linked to a greater loss in lung function	55	38	6	1
It is difficult for most patients to cope with COPD	29	50	19	2

Figure 1 Physician perception about patient access to treatment: Continuing to Confront COPD International Survey, 2012–2013.

Note: Columns do not always sum to 100% due to rounding or missing values.
Abbreviations: NL, the Netherlands; SK, South Korea.

Figure 2 Comparison of physician and patient beliefs about treatment effectiveness: Continuing to Confront COPD International Survey, 2012–2013.

Figure 3 Comparison of physician and patient beliefs about smoking as a risk factor for COPD: Continuing to Confront COPD International Survey, 2012–2013.

Figure 4 Comparison of physician- and patient-reported smoking cessation counseling practices: Continuing to Confront COPD International Survey, 2012–2013.

Figure 5 Comparison of physician- and patient-reported lung function testing practices: Continuing to Confront COPD International Survey, 2012–2013.

Table S1 Physician beliefs about COPD outlook compared to 10 years ago by country: Continuing to Confront COPD International Survey, 2012–2013

	Total (N=1,307)	USA (N=200)	Mexico (N=101)	Brazil (N=101)	France (N=100)	Germany (N=100)	Italy (N=100)	Spain (N=100)	UK (N=100)	NL (N=101)	Russia (N=100)	Japan (N=101)	SK (N=103)
Compared to 10 years ago, would you say the long-term health outlook for patients with COPD has become better, become worse, or has stayed about the same?
Become worse (%)	4	2	13	0	5	2	1	5	0	1	10	4	8
About the same (%)	18	23	9	12	17	18	5	10	13	19	35	18	26
Become better (%)	79	76	78	88	78	80	94	85	87	80	55	78	66
Among physicians who reported that outlook had “become better”, ‘Why has the long-term health outlook improved for patients with COPD?’*
Better medications for COPD (%)	86	89	86	90	83	90	79	88	84	89	75	84	90
Increased smoking cessation/less passive smoking exposure (%)	28	39	15	19	19	15	16	20	40	36	38	32	51
More public acceptance and knowledge about COPD (%)	22	23	38	26	23	26	9	20	22	30	11	14	26
Better diagnostics/earlier diagnosis of COPD (%)	21	18	29	11	33	21	31	38	21	12	25	4	9
Increased access to COPD medication (%)	15	7	9	13	5	6	29	12	23	11	53	11	22
Better treatment of comorbidities and symptoms associated with COPD (%)	10	7	13	12	3	9	5	12	14	4	44	4	4
Better disease management/more frequent follow-up of patients with COPD (%)	10	2	9	3	29	14	1	16	13	21	0	0	12
Pulmonary rehabilitation/physiotherapy (%)	9	10	6	11	8	6	1	4	23	11	27	5	3
Better adherence to COPD treatment (%)	9	8	6	9	6	11	16	7	3	2	18	4	15
Better-trained physicians/Availability of guidelines and tools for physicians (%)	9	3	11	4	10	5	17	5	9	9	36	6	0
Long-term oxygen therapy (%)	6	3	3	3	5	5	1	2	11	4	27	10	7
Reduced exposure to harmful environmental factors (%)	2	1	3	0	3	3	0	0	1	2	0	4	18

Notes:

* Percentages for each country will sum to greater than 100%; results from an open-ended question asking physicians to provide reasons why they believe the health outlook for patients with COPD has improved; predefined list provided.

Abbreviations: COPD, chronic obstructive pulmonary disease; NL, the Netherlands; SK, South Korea.

Table S2 Physician beliefs and knowledge about COPD prognosis and treatment by country: Continuing to Confront COPD International Survey, 2012–2013

	Total (N=1,307)	USA (N=200)	Mexico (N=101)	Brazil (N=101)	France (N=I00)	Germany (N=100)	Italy (N=100)	Spain (N=I00)	UK (N=I00)	NL (N=101)	Russia (N=100)	Japan (N=101)	SK (N=103)
No current treatments reduce mortality or halt COPD progression
Strongly agree or somewhat agree (%)*	46	43	43	36	28	29	42	39	50	55	81	42	67
Inflammation is a key component of COPD and should be treated
Strongly agree or somewhat agree (%)*	92	95	96	95	90	94	95	95	90	86	87	93	97
More frequent exacerbations are linked to a greater loss in lung function
Strongly agree or somewhat agree (%)*	93	96	91	86	89	86	89	89	95	92	100	93	98
It is difficult for most patients to cope with COPD
Strongly agree or somewhat agree (%)*	79	87	88	88	68	69	84	70	74	85	90	42	92

Notes:

* From four possible responses (strongly agree, somewhat agree, strongly disagree, and somewhat disagree).

Abbreviations: COPD, chronic obstructive pulmonary disease; NL, the Netherlands; SK, South Korea.

Table S3 Reasons why patients with COPD do not have access to the treatment the physician wishes to prescribe, by country: Continuing to Confront COPD International Survey, 2012–2013

	Total (N=1,307)	USA (N=200)	Mexico (N=101)	Brazil (N=101)	France (N=100)	Germany (N=100)	Italy (N=100)	Spain (N=100)	UK (N=100)	NL (N=101)	Russia (N=100)	Japan (N=101)	SK (N=103)
Among physicians who indicated that 1%–100% of their patients have issues accessing their treatment: ‘Why do your chronic obstructive pulmonary disease patients not have access to their treatment?’*
Preferred treatment too expensive for patient/insurance issues (%)	70	98	93	94	58	69	12	75	34	11	81	57	49
Preferred treatment not on hospital/clinic formulary (%)	13	2	48	6	4	11	12	11	29	6	35	10	3
Local guidelines do not recommend preferred treatment (%)	10	1	4	4	4	3	18	13	29	11	1	8	46
Patient inability to use device or understand how to use preferred treatment (%)	4	3	1	0	2	3	0	7	3	16	0	12	4
Patient refuses to use the preferred treatment (%)	3	2	0	1	9	0	24	0	3	11	0	4	3
Poor patient adherence to preferred treatment (%)	3	1	1	1	4	0	12	0	0	11	0	2	5
Preferred treatment has side effects/risk of contraindication (%)	2	0	0	0	4	0	0	0	0	19	0	2	1
Preferred treatment has poor efficacy (%)	1	0	0	0	0	0	0	0	0	5	0	1	1
Patient lives alone or has transportation issues (%)	1	2	0	0	2	0	0	0	0	0	0	1	0

Notes:

* Percentages for each country will sum to greater than 100%; results from an open-ended question asking physicians to provide reasons why they believe their patients with COPD cannot access treatment; no predefined list provided.

Abbreviations: COPD, chronic obstructive pulmonary disease; NL, the Netherlands; SK, South Korea.

Table S4 Physician perception of patient compliance with treatment instructions, by country: Continuing to Confront COPD International Survey, 2012–2013

	Total (N=1,307)	USA (N=200)	Mexico (N=101)	Brazil (N=101)	France (N=100)	Germany (N=100)	Italy (N=100)	Spain (N=100)	UK (N=100)	NL (N=101)	Russia (N=100)	Japan (N=101)	SK (N=103)
Approximately what percentage of your patients on maintenance medication for their COPD comply fully to their treatment instructions?
76%–100%	15	16	13	21	15	15	26	16	12	5	11	17	13
51%–75%	45	50	52	48	49	40	28	51	57	53	7	53	47
26%–50%	30	25	25	26	29	38	38	28	27	38	33	28	31
1%–25%	10	8	11	6	7	7	7	5	4	5	47	3	9
None	1	1	0	0	0	0	1	0	0	0	2	0	1
In your experience, how much of a problem are the following when it comes to patients’ compliance with their medication regimens for COPD? Troublesome side effects (%)
Major problem	26	13	26	28	32	27	19	34	14	11	54	58	13
Minor problem	59	77	58	53	53	69	48	56	73	58	39	40	60
Not a problem	15	10	16	19	15	4	33	10	13	31	6	2	27
Patients do not perceive a benefit of treatment (%)
Major problem	46	47	48	30	55	39	40	37	45	47	55	66	44
Minor problem	43	44	41	49	34	48	38	51	47	46	34	31	51
Not a problem	11	9	12	22	11	13	21	12	8	8	9	3	5
The cost of medications (%)
Major problem	44	89	81	86	8	18	18	32	8	6	62	50	24
Minor problem	34	10	16	12	48	48	30	54	30	40	33	43	69
Not a problem	22	1	3	2	44	34	51	14	62	54	5	7	7
Inconvenience of dosing schedule (%)
Major problem	26	20	22	33	31	27	17	28	19	22	29	50	24
Minor problem	57	66	60	53	45	65	48	58	66	64	44	49	61
Not a problem	16	14	18	14	24	8	35	14	15	14	25	1	15
Low patient education or poor understanding of disease (%)
Major problem	57	52	50	57	64	57	66	67	54	47	57	69	50
Minor problem	38	43	43	37	34	37	28	30	45	51	31	28	44
Not a problem	5	5	8	6	2	6	6	3	1	2	11	3	6
Poor inhaler technique (%)
Major problem	60	43	52	34	72	67	70	87	71	79	60	60	46
Minor problem	35	52	37	55	26	30	19	13	28	21	34	38	50
Not a problem	5	5	11	11	2	3	11	0	1	0	5	2	5
Forgetfulness (%)
Major problem	35	29	37	28	39	37	52	39	39	28	27	54	14
Minor problem	54	63	50	61	52	59	36	56	56	59	44	39	61
Not a problem	11	8	13	11	9	4	12	5	5	13	26	7	25
Difficulty managing multiple medication regimens (%)
Major problem	52	61	47	62	40	56	52	64	60	51	48	41	34
Minor problem	41	38	49	34	52	40	36	32	34	45	25	53	59
Not a problem	7	1	5	4	8	4	12	4	6	4	27	6	7

Abbreviations: COPD, chronic obstructive pulmonary disease; NL, the Netherlands; SK, South Korea.

Table S5 Comparison of physician and patient beliefs by country: Continuing to Confront COPD International Survey, 2012–2013

	Total (N=1,307)	USA (N=200)	Mexico (N=101)	Brazil (N=101)	France (N=100)	Germany (N=100)	Italy (N=100)	Spain (N=100)	UK (N=100)	NL (N=101)	Russia (N=100)	Japan (N=101)	SK (N=103)
There are no truly effective treatments for COPD
Physicians strongly agree or somewhat agree (%)*	39	19	53	38	37	22	38	32	48	39	72	39	59
Patients strongly agree or somewhat agree (%)*	46	40	50	46	53	50	26	45	55	37	43	47	63
Smoking is the cause of most cases of COPD
Physicians strongly disagree or somewhat disagree (%)*	3	2	3	3	2	3	3	4	0	4	3	3	5
Patients strongly disagree or somewhat disagree (%)*	31	32	31	19	21	43	36	21	19	36	19	48	39
Smoking cessation counselling practices
Physicians counsel smokers at every visit (%)	68	73	84	88	57	44	87	79	60	44	77	47	65
Patients who smoke or quit in the past year Doctor has discussed stopping smoking in the past 12 months (%)	71	82	66	87	72	35	86	74	81	59	66	47	70
Lung function testing practices
Physicians use spirometry to diagnose COPD (%)	86	88	88	95	63	97	37	97	100	97	100	85	86
Patients ever had a lung function test (%)	76	89	57	76	28	95	56	89	88	91	59	85	78

Notes:

* From four possible responses (strongly agree, somewhat agree, strongly disagree, and somewhat disagree).

Abbreviations: COPD, chronic obstructive pulmonary disease; NL, the Netherlands; SK, South Korea.

Table S6 Multivariate model of predictors of patient’s disagreement* with the statement “Smoking is the cause of most cases of COPD”: Continuing to Confront COPD International Survey, 2012–2013

Patient characteristic	Odds ratio (95% CI)
Smoking status
Current smoker	Ref
Former smoker	1.6 (1.3, 1.9)
Never smoker	4.4 (3.6, 5.4)
Exposed to dust or fumes from cooking, burning, mining, welding, etc, for a year or more
Yes	1.2 (1.0, 1.4)
No	Ref
Age (years)
40–49	1.8 (1.4, 2.2)
50–59	1.6 (1.3, 1.9)
60–69	1.1 (0.9, 1.4)
70+	Ref
Sex
Male	Ref
Female	1.5 (1.3, 1.7)
Education level
High school (secondary school) or less	Ref
Some/completed university or technical training	1.3 (1.1, 1.5)
Qualifying diagnosis
Physician-diagnosed COPD	0.6 (0.4, 0.7)
Physician-diagnosed chronic bronchitis	0.5 (0.4, 0.6)
Symptom-based definition of chronic bronchitis	Ref

Notes: All factors associated with disagreement in univariate analysis were entered into a backward elimination model; only statistically significant variables (displayed above) and country were retained in the final model;

* strongly disagreed or somewhat disagreed with the statement.

Abbreviations: COPD, chronic obstructive pulmonary disease; CI, confidence interval; Ref, reference category.