23 Severe exacerbations are also associated with a significant increase in mortality, 24 making prevention of exacerbations the key goal in management of COPD. 4, 17-22 Exacerbations are a major contributor to disease progression, with accelerated lung-function decline in patients who experience exacerbations, and the greatest decline seen in patients with mild disease. Numerous studies have documented the association between exacerbation history and future exacerbation events ( Table 1). Interestingly, even a single exacerbation could result in a significant increase in the rate of decline in lung function 15 and a sustained worsening of health status in patients with acute exacerbation of chronic bronchitis who likely had COPD as well. 14 These results suggest that treatments that reduce exacerbation frequency could have a significant impact on health status and disease progression. 12, 13 In another study, symptom burden and exacerbation frequency were strongly correlated with the health-related quality of life in patients with moderate or severe COPD. 11 In two separate studies, frequent exacerbations contributed to a long-term decline in lung function (measured as forced expiratory volume in 1 second ) in patients with moderate-to-severe COPD. Furthermore, recovery of lung function and symptoms to baseline levels following an exacerbation was found to occur more slowly with each additional year of disease, making it harder for patients to recover from exacerbations over time.
9 This suggests that lung function may undergo accelerated decline and may not fully recover following an exacerbation. 9, 10 In one prospective trial, the mean recovery time for symptoms to return to baseline levels following an exacerbation event was ~14.5 days, while the recovery of peak expiratory flow to patient baseline levels did not occur within 99 days for ~7% of exacerbations. Increases in exacerbation frequency, severity, and length of recovery period have all been shown to significantly reduce health-related quality of life for patients with COPD. We discuss how appropriate treatment can improve patient outcomes and reduce healthcare use and associated costs. 8 This review provides an overview of the impact of COPD on patients and, more broadly, the impact on the health system overall, and reviews the latest management guidelines for patients with COPD. 1 The expansion of the Affordable Care Act Hospital Readmissions Reduction Program in 2014 to include COPD has highlighted the need for better management to reduce frequent hospitalizations and readmissions associated with severe disease. 4-7 Also, there is a positive correlation between disease severity and higher treatment costs. Exacerbations of COPD are a major contributor to the economic burden and, depending on severity, can result in the need for emergency department (ED) visits and hospitalizations.
3ĬOPD is defined as being “stable” when symptoms are well managed and pulmonary decline is minimized, while management of “unstable” COPD (in patients who experience frequent or severe exacerbations and a faster decline in pulmonary function) can be more challenging. 1 Despite recommendations that maintenance pharmacotherapy be used for patients with moderate-to-severe COPD, 1 up to 71% of patients from a Medicare population did not receive maintenance therapy, highlighting opportunities for improvements in patient management and care. 2 Incidence of COPD is highest in patients who smoke or have a history of tobacco use, those older than 40 years, and men.
1 COPD is estimated to affect about 16 million adults in the United States. Increased awareness of treatment recommendations among prescribers and COPD aftercare programs that provide patient support through education and inhaler technique training, in addition to pulmonary rehabilitation and follow-up appointments, also have been shown to improve patient outcomes and reduce hospitalizations.Ĭhronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with airway obstruction and is characterized by persistent respiratory symptoms.