Community-Acquired Pneumonia Causes Significant Burden for Vulnerable COPD Population

Community-acquired pneumonia (CAP), which carries a high morbidity and economic burden worldwide, can be even more physically and economically devastating to individuals with COPD, according to a new study posted online in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. The study was conducted by the COPD Foundation in collaboration with and funded by Pfizer Inc.

“Patient-Reported Consequences of Community-Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease,” one of the first studies to include only COPD participants and individuals younger than 60, concluded that individuals with COPD suffering from CAP will miss an average of 21 days from work, be impaired from normal activities for more than 30 days and experience weeks of lingering symptoms.

Study Methods

Nearly 500 individuals with COPD who had also recently received a CAP diagnosis completed one survey within 120 days of their initial CAP diagnosis and a second survey 30 days later via the secure online, interactive patient registry—the COPD Patient-Powered Research Network (COPD PPRN). Participants were recruited via multiple routes including posts on the COPD Foundation’s COPD360Social online network, Facebook posts and outreach to existing research participants in the COPD PPRN.

Participants’ CAP diagnoses were self-reported without medical record verification, however 96.5% of participants stated they did have a chest radiograph or computerized tomography to diagnose or confirm their CAP.

The initial survey collected participants’ demographic information (age, gender, education, income, employment, insurance status, living arrangements) along with self-reported information on comorbidities. Participants also completed a CAP Burden of Illness Questionnaire (CAP-BIQ) to assess symptoms, duration of symptoms and impact on work, activities and family. The second, follow-up survey focused on CAP symptoms that participants had reported as unresolved at the time the initial survey was completed.

Study Results

The study’s results show that all the COPD-CAP-diagnosed participants experienced multiple symptoms including cough, breathlessness, and fatigue, often requiring weeks to recover and resulting in missing work and participation in usual activities. In addition to respiratory symptoms, participants experienced weakness, poor appetite, confusion or trouble thinking, body aches, and pain associated with their coughs. More than 84% reported requiring assistance from family and friends. The symptoms and resulting burden were greater and lasted for a longer period than reported in the general community of CAP diagnosed individuals without COPD accessed in previous CAP studies. (For more discussion on these previous studies, visit the full study article here.)

“Our study is one of the first to focus on the impact of CAP in a cohort limited to individuals diagnosed with COPD,” explains lead study author Cara Pasquale, MPH, Senior Director of the COPD Patient-Powered Research Network at the COPD Foundation. “The majority of our study’s participants were younger than 60 and therefore more likely to still be working.”

The mean age of participants was 48.5 years old (compared to previous CAP studies’ mean ages of greater than 61 years) and less than 10% of participants were 65 years of age or older.

Among the participants employed part or full time, 96.9% reported missing work with an average of 21.6 days of missed work and another 14 days required to return to “usual” job performance. For those not working, 87.5% reported missing 1 or more days of usual activities with an average of 36.1 days missed, and an additional 10 days on average to return to their usual activity performance. Participants reported an average of 28.2 days of help was needed from family and friends. Over 90% of participants reported being hospitalized for their CAP.

Conclusions

“This study demonstrates that CAP is a serious and burdensome condition for individuals with COPD by using patient reported information that is seldom shared in most medical encounters or collected in medical records. It confirms the need for people with COPD to review their pneumonia and flu vaccinations with their doctor or health care professional to make sure all immunizations are up to date.” states Barbara P. Yawn, MD, MSc, study co-author and Chief Scientific Officer at the COPD Foundation. “We need to encourage healthcare professionals to improve their immunization rates for annual influenza and pneumococcal vaccinations among the COPD patient population—a population of almost 15 million in the United States alone.”

The 2016 Behavioral Risk Factor Surveillance System —a system of health-related phone surveys that conducts 400,000 interviews across all 50 U.S. states each year—reports 64.3% of individuals with COPD self-reported having received a pneumococcal vaccine and the Centers for Disease Control and Prevention (CDC) reports that 66.9% of adults ≥65 years of age received a pneumococcal vaccine (2016 data).1,2 In addition, the Centers for Disease Control and Prevention reports that 43.3% of adults ≥18 years of age received a flu vaccine during the 2016-2017 influenza season.3 These statistics are below the recommended goals for vaccination of 70% (pneumococcal vaccine) and 90% (flu vaccine) set by the Healthy People 2020 ten-year health promotion/disease prevention initiative launched by the U.S. Department of Health and Human Services.4

“Smoking cessation is also a critical prevention strategy,” Dr. Yawn continued. “Almost half of this study's participants reported being current smokers. Clearly, this provides for a significant prevention opportunity including continued smoking cessation, support and education including review for relapses.”

To read the full “Patient-Reported Consequences of Community-Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease” study, visit here.

References

1. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System. CDC web site. https://www.cdc.gov/brfss/about/ Published May 16, 2014. Accessed January 2019.
2. Centers for Disease Control and Prevention (CDC). Health insurance coverage: early release of estimates from the National Health Interview Survey, 2016. CDC website.

This page was reviewed on February 13, 2020 by the COPD Foundation Content Review and Evaluation Committee