Chronic obstructive pulmonary disease and exacerbations: clinician insights from the global Hidden Depths of COPD survey

Abstract

Objective:

This real-life, global study aimed to investigate current views of and clinical practice in the management of COPD and its exacerbations, among clinicians from both the primary and secondary care settings.

Methodology:

We devised an online questionnaire about COPD management and invited 13,613 general practitioners (GPs) and respiratory specialists to respond. Participating clinicians, recruited from an established research panel, treated a minimum of 10 (GPs) or 20 (respiratory specialists) patients with COPD per month. Completed responses were collected from 1400 clinicians from 14 countries.

Results:

A third of GPs and respiratory specialists reported that the main goal of COPD management was to improve patients’ quality of life; only 14% of GPs thought that the prevention of exacerbations was a priority.

The study showed a strong preference for inhaled corticosteroids in combination with other treatments, rather than as sole therapy, in line with global guidelines. Fewer GPs than respiratory specialists routinely recommended anticholinergics, pulmonary rehabilitation or oxygen therapy.

Clinicians reported that 55% (GPs) and 57% (respiratory specialists) of their COPD patients had experienced an exacerbation in the previous 12 months. Although higher than those reported in clinical trials, these rates were lower than patients’ own estimates from a corresponding patient survey, even in mild COPD patients (62%; 80% in severe patients). Despite this, 74% of GPs and 67% of respiratory physicians reported satisfaction with therapies to prevent exacerbations.

Conclusions:

This global survey revealed that clinicians’ main goal when managing COPD was to improve the lives of their patients, and that few viewed reducing exacerbations as a priority. Despite a relatively high level of adherence to treatment recommendations, it appears that clinicians, particularly GPs, underestimate the frequency and impact of exacerbations. These results suggest a need to raise awareness of exacerbations among both GPs and respiratory specialists.

Keywords::

• Clinician-reported
• COPD
• Exacerbation
• Survey

Transparency

Declaration of funding

The Hidden Depths of COPD survey was sponsored by an educational grant from Takeda Pharmaceuticals International GmbH. A steering committee of COPD experts including primary and secondary care physicians designed the survey in conjunction with six representatives of the sponsor. This included the original study design and concept, the plan for the analyses, full access to the data and responsibility for decisions with regard to publication.

Authors’ contributions: All authors have made substantial intellectual contributions to the conception and design of the survey and the analysis and interpretation of the data. They have all been involved in drafting the manuscript or revising it critically for important intellectual content.

Declaration of financial/other relationships

N.B. has received honoraria for giving talks for the following companies: GlaxoSmithKline, AstraZeneca, Chiesi, Boehringer Ingelheim, Novartis, Teva and Takeda. P.M.A.C. has served on Scientific Advisory Boards of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis and Takeda and has received research funding from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Takeda. A.K. has served on advisory boards for Boehringer Ingelheim, AstraZeneca, Takeda, Graceway, Novartis, Pfizer and Purdue. He has been given honoraria for giving talks for the above companies and Merck Frosst and Sanofi. K.F.R. has received research funding from Novartis, AstraZeneca, MSD and Takeda. He has also provided consultation services for AstraZeneca, Chiesi, Novartis, MSD and GlaxoSmithKline.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors thank ICM Research who managed the data collection. They acknowledge Jenny Bryan, freelance medical writer, and Helen Clark from FTI Consulting, who provided medical writing services on behalf of Takeda Pharmaceuticals International GmbH. They also thank Ileana Stoica (senior medical writer) at Synergy Vision, UK, for the provision of medical writing, which was funded by Takeda Pharmaceuticals International GmbH.

Previous presentation: Abstract 56, 2nd IPCRG Scientific Meeting, 26–27 May 2011, Amsterdam; and CHEST 2011, 22–26 October, Honolulu, Hawaii.