Choose your outcomes: From the mean to the personalized assessment of outcomes in COPD. An exploratory pragmatic survey.

Abstract

BACKGROUND: Patient's expectations and needs may influence adherence in chronic obstructive pulmonary disease (COPD). The objectives of this survey were to assess the specific outcomes that patients expected their COPD treatment to improve (patient's personal outcome [PPO]) and to evaluate how the ongoing therapy was able to reach this objective. METHODS: We performed an exploratory pragmatic survey of COPD patients attending 2 university hospitals for scheduled follow-up visits. Patients had to indicate their PPO, the effect of ongoing treatment on the PPO, the symptom COPD of they expected treatment to improve and how this symptom is currently bothering them. Patients also underwent assessment of lung function and completed the COPD assessment test (CAT). RESULTS: We analyzed data from 144 consecutive patients, (62.5% males; age range 54-94; mean age 73.88±8.33). A total of 23 different PPOs were scored, and 44.5% of patients reported an improvement ≥6 (mean 4.93±2.27 on a 0-10 points scale) due to ongoing treatment. The correlation between perceived improvement in PPO and CAT score was weak and negative (r=-0.13, p=0.11), whereas it was high and significant with FEV1 (r=.35, p=0.007). The clinical features patients most expected their ongoing treatment to improve were breathlessness (64.6% of patients), cough (13.9%), sputum production (11%) and episodes of exacerbation (8.3%), for which their scores were, respectively, 7.12±1.99, 6.8±2.24, 6.63±2.13, and 8.0±0.94. CONCLUSION: Appropriate assessment of PPO could lead to better long-term management of COPD.