SESSION TITLE: Respiratory Care Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Symptom control in COPD management is emphasized by the 2011 GOLD strategy update which recommends evaluation using questionnaires such as the COPD Assessment Test (CAT). This research aimed to quantify the relationship of COPD symptoms with measures of health status.
METHODS: Data were taken from 3 cross sectional surveys of US COPD patients (2011-2013). Primary care physicians and pulmonologists recorded clinical data (demographics, comorbidities and treatment) for the next 5 COPD patients being seen for routine care. Patients were invited to complete the CAT, EuroQol five dimensions questionnaire (EQ-5D) and Jenkins Sleep Evaluation Questionnaire (JSEQ). High symptom patients (CAT≥24) were matched to low (CAT<24), using 1:1, propensity score matching with replacement on age, sex, BMI, smoking status, exacerbation history and comorbidities as covariates. Match balance was assessed using standardised mean differences (SMDs). Differences in EQ-5D utility index and JSEQ scores were reported comparing high and low symptom matched patients. Rosenbaum bounds were generated to assess the sensitivity of the results. All patients had been on inhaled COPD treatment for a minimum of 3 months before assessment.
RESULTS: Of the 638 included patients (mean age 66.4 years; 56.7% male), 257 pairs of high and low patients were matched and all covariates were adequately balanced (SMDs <|10%|). EQ-5D score was lower (p<0.0001) for patients with high symptoms (0.709) vs. low (0.847), exceeding the minimally important difference of 0.074. JSEQ score was higher (p<0.0001) for patients with high symptoms (7.3) vs. low (3.7; 0=no sleep problems, scale 0-20). Single maintenance bronchodilators (+/- inhaled corticosteroids) were received by 45.9% of high symptom patients, while short-acting-only and triple therapy (ICS/LABA/LAMA) accounted for 8.2% and 40.5% respectively. Sensitivity analysis indicated the results were robust and insensitive to unobserved confounders.
CONCLUSIONS: COPD symptoms as measured by the CAT have a significant negative impact on health status (EQ-5D) and sleep (JSEQ).
CLINICAL IMPLICATIONS: Over half of patients with high symptoms were not receiving optimal bronchodilation and therefore may benefit from an additional bronchodilator to address their symptoms, and see related improvements in their quality of life and sleep.
DISCLOSURE: Barry Make: Consultant fee, speaker bureau, advisory committee, etc.: Novartis â medical advisory board; consultant to develop/review protocol, assist in data analysis, abstract development/review The following authors have nothing to disclose: Jessica Marvel, Tzy-Chyi Yu, Robert Wood, Tom Burke, Mark Small, Victoria Higgins
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