AI Summary & Key Takeaways
AI InsightConsequently, our results demonstrate that COPD is not a disease of only the elderly, is an important healthcare issue that often disrupt daily living of the patients due to inadequate disease awareness leading to overlooking of the symptoms by patient and physicians, and that a patient-centered approach based on the living standards, life expectancies and preferences of patients was crucial in patient management.
📌 3 Key Takeaways
Abstract
Chronic obstructive pulmonary disease (COPD) is a lung disease characterized with limitation of airflow that is not completely reversible, progressive deterioration of airways and systemic inflammation. This study has been planned to determine daily symptom variability of patients, expectations of patient and physicians from treatment and patient profiles. A total of 514 patients with COPD from 25 centers were included in this national, multicenter, cross-sectional observational study. Data regarding demographic features, concomitant diseases, history and treatment of COPD and expectations of patients and physicians were all obtained in a single visit. Mean [standard deviation (SD)] age of the patients was 64.1 (9.5) years; age range was 41-92 years, 50% of the patients were younger than 65 years and 91% were males. Educational level of the patients was at least primary school in 80.2%; and 54.3% (30.4%) of the patients had at least one concomitant disease, particularly a cardiovascular disease. Mean (SD) duration of having COPD was 5.4 (4.6) years. The majority of patients were at moderate (43.2%) and severe (35.0%) COPD stages and one or more exacerbations per year was determined in 71%. Inhaled beta-2 agonists (84.2%), inhaled steroids (76.3%) and inhaled long-acting anti-cholinergics (70.0%) were the most commonly used medications. Dyspnea (99.0%), sputum production (92.8%) and wheezing (90.5%) were the most common symptoms, and symptom variability for dyspnea (41.1%), sputum production (61.0%) and cough (53.5%) were seen the most in the morning hours (p< 0.001). Most commonly affected morning activity was climbing up/down the stairs (point of effect: 6.7), followed by wearing socks/shoes (point of effect: 4.3) and showering/bathing (point of effect: 4.2) by COPD. Major treatment expectations of patients were greater symptomatic relief (82.3%) and greater mobility (70.0%), faster symptomatic relief (61.1%) and improvement in morning activities (59.3%); while major treatment expectations of physicians included increased quality of life (100.0%) and decreased morbidity (96.0%). Quitting smoking was the most commonly recommended (88.3%) and implemented (67.9%) non-drug protective approach aimed at decreasing the frequency of exacerbations. Consequently, our results demonstrate that COPD is not a disease of only the elderly, is an important healthcare issue that often disrupt daily living of the patients due to inadequate disease awareness leading to overlooking of the symptoms by patient and physicians, and that a patient-centered approach based on the living standards, life expectancies and preferences of patients was crucial in patient management.
Özet
Bu ulusal, çok merkezli, kesitsel gözlem çalışmasına, 25 merkezden toplam 514 kronik obstrüktif akciğer hastalığı (KOAH) olan hasta dahil edildi. Hastaların demografik özellikleri, eşlik eden hastalıklar, KOAH öyküsü ve tedavisi, hasta ve hekimin tedavi beklentisine yönelik veriler tek bir vizitte toplandı. Hastaların yaş ortalaması [standart sapma (SS)] 64.1 (9.5) yıl; yaş aralığı 41-92 yıl, %50'si 65 yaşın altında ve %91'i erkekti. Hastaların %80.2'si en az ilkokul mezunu; %54.3 (%30.4)'ünde kardiyovasküler hastalıklar başta olmak üzere en az bir eşlik eden hastalık bulunuyordu. KOAH hastalık süresi ortalama (SS) 5.4 (4.6) yıldı. Hastaların çoğunluğu orta (%43.2) ve şiddetli (%35.0) KOAH evresinde olup, %71'inde yılda bir veya daha sık alevlenme tespit edildi. İnhale beta-2 agonistler (%84.2), inhale steroid (%76.3) ve uzun etkili inhale antikolinerjikler (%70.0) sıklıkla kullanılan ilaçlardı. Dispne (%99.0), balgam çıkarma (%92.8), öksürük (%92.0) ve hırıltılı solunum (%90.5) olgularda en sık gözlenen semptomlar olup, dispne (%41.1), balgam çıkarma (%61.0) ve öksürük (%53.5) en çok sabah saatlerinde değişkenlik gösteriyordu (p< 0.001). En çok etkilenen sabah aktivitesi merdiven inme/çıkma (etki puanı 6.7), takiben çorap/ayakkabı giyme (etki puanı 4.3) ve duş yapma/yıkanma (etki puanı 4.2) idi. Semptomlarda daha fazla rahatlama (%82.3) ve daha fazla hareket edebilme (%70.0), semptomların daha hızlı iyileşmesi (%61.1) ve sabah aktivitelerinde rahatlama (%59.3) hastaların; yaşam kalitesini artırmak (%100.0) ve morbiditeyi azaltmak (%96.0) ise hekimlerin başlıca tedavi beklentileri idi. Sigara içmeme, alevlenmeyi önleme amacıyla en sık önerilen (%88.3) ve uygulanan (%67.9) ilaç-dışı koruyucu yaklaşımdı. Sonuç olarak; bulgularımız KOAH'ın sadece yaşlı hastalara özgü olmayıp, semptomların hasta ve hekim tarafından atlanmasına yol açan yetersiz farkındalık nedeniyle çoğu zaman hastaların günlük yaşamlarını bozan önemli bir sağlık sorunu olduğuna ve hastalık yönetiminde hastaların yaşam koşulları, hayat beklentileri, endişeleri ve tercihlerini esas alan hasta merkezli yaklaşımın önemine işaret etmektedir.