The Importance of Comorbidities in Managing COPD

In 2006 at the American Thoracic Society’s International Conference in San Diego, the COPD Foundation presented the results of the survey it took on COPD and co-morbidities. Dr. Byron Thomashow and John W. Walsh, presented the results of a survey conducted to 1,003 over the telephone (from an existing list of households in which at least one person reported a diagnosis of COPD), and 2,029 Internet surveys which were completed from COPD patients referred from national COPD organizations.

THE SURVEY

The goal of this survey was to study the incidence of co-morbid diseases and impact on care received of individuals diagnosed with COPD. Previously this topic was relatively unstudied. The survey instrument had over 75 questions and addressed conditions such as diabetes, osteoporosis, depression, heart disease, and stroke, among others. Results of the study indicate co-morbidities are extremely common in the COPD population and add significantly to the complexity and cost of COPD care. The survey also suggested that despite significant symptoms, limitations, and health care utilization, surveyed COPD patients appear to be receiving less than maximal medical COPD therapy yet seem remarkably satisfied with the level of care. Those better connected to national COPD organizations appear to receive COPD care closer to suggested guidelines.

CO-MORBIDITY FINDINGS

The main objective of the COPD and Co-Morbidities Survey was to explore what chronic diseases COPD patients suffer, the extent of these illnesses and whether the patient is taking medications for these additional illnesses. 81% percent ofCOPD patients in the household sample described having over 6 co-morbid conditions as compared to 69% in organizational sample. The breakdown revealed that 19% of the household sample reported 1 to 5 co-morbidities as compared 30% of the organizational sample, while 47% reported 6-10 co-morbidities in the household sample as compared to 53% of the organization sample. For those reporting 11-15 co-morbidities, over one-fourth (27%) of the household sample reported this number while only 14% of the organization sample reported 11 to 15 additional illnesses. Finally, 7% of the household sample reported over 16 co-morbidities while only 2% of the organization sample reported this number. The higher number of co-morbidities in the household sample corresponds to their worse health status. This greater number of co-morbidities also correlates to the larger number of pills taken daily as reported earlier: 59% of individuals in the household sample reported taking over 5 prescription medication per day compared to 48% in the organizational sample.

OTHER FINDINGS

The study found that the majority despite preconceptions, COPD affected more women than men; in both groups, female respondents were more prevalent with 58% of household respondents being female as compared to 64% of organization respondents. Thus, overall 38% of survey respondents were male with 62% being female.

Results also showed that 30% of respondents in the household sample reported their health status as poor, 35% as fair, 25% as good and 8% as very good. This compares to only 21% of the organization sample as reporting their health status as poor, 35% as fair, 30% as good and 12% as very good. Thus, only 35% of the household sample views their health as good or better as compared to 44% of the organization sample.

Interestingly, while the household sample self-reported a relatively poor health status, they were less critical of the medical care they received while the organization sample was more critical despite better self-reported health. When asked how satisfied they were with the medical care they receive, over half of the household sample (55%) as compared to two-fifths of the organization sample (42%) said they were very satisfied. An additional third of the household sample and 45% of the organization sample said they were somewhat satisfied. Only 14% of the household sample and 13% of the organization sample were either somewhat or very dissatisfied with their medical care. It appears that overall these patients believe their health cannot be seriously improved.

COPD patients in both samples were asked how well informed they felt they were about their condition and treatment. Over 80% in both samples believed they were adequately or very well informed about their condition. Interestingly, nearly half of the household sample considers themselves very well informed as compared to only one-third of the organization sample. However other findings suggest the household sample is over-confident in their knowledge ofCOPD and its treatment. The most common sources of information were physicians (93% of the household and 86% of the organization sample), nurses (57% of the household as compared to 43% of the organization sample), books and magazines (46% household and 43% organization), television or cable (30% household and 13% organization) and the Internet (69% household and 90% organization). Of note only 12% of the household sample and 26% of the organization reported getting COPD information from patient organizations. Also of note, the Internet is the main source of information for the organization sample and the second most important source for the household sample.

Below is a table describing the prevalence of co-morbidities of those interviewed:

CONCLUSION

Conclusions that were drawn from the survey findings could be described in three points:

1. Despite significant symptoms, limitations and health care utilization, surveyed COPD patients appear to be receiving less than maximal medical therapy yet seem satisfied with the level of care.
2. Those better connected to national COPD organizations appear to receive COPD care closer to guidelines.
3. Co-morbidities are very common and add to the complexity and cost.

In an era of increasing physician time restraints, these multiple medical problems plus overall patient satisfaction withCOPD care may prevent COPD from receiving the attention it deserves. Therefore, it is important to address the knowledge gap issues in medical professional education, and in the patient population.