Overview
Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe airflow obstruction that is associated mainly with emphysema and chronic bronchitis.
COPD has affected tens of millions of Americans. One current estimate is that 6.5 million patients have been diagnosed with some form of COPD and as many as 15.2 million more have been left undiagnosed.1 Government data based on a 1998 prevalence survey suggested that three million Americans have been diagnosed with emphysema and nine million have been affected by chronic bronchitis.2 In 1998, COPD was the fourth leading cause of death in the United States, accounting for more than 112,000 deaths.3
Surprisingly little has been learned about COPD. Studies of the disease burden on patients with COPD have been scarce, and the social and healthcare costs of the disease have not been well quantified. As a result, there have been limited data about COPD symptoms and severity, disability or activity limitations, lifestyle impact, social and psychosocial consequences, healthcare utilization, and patterns of treatment.
Confronting COPD in America was designed to help answer some of these questions and unmask one of the nation's least understood public health problems. It was the largest and most comprehensive US survey to date of patient and provider knowledge, attitudes, and behavior related to COPD. Among the issues it explored were the frequency and severity of symptoms, the burden of illness, healthcare utilization, disease management and treatment, and quality of life issues.
The survey yielded several major findings, such as:
- COPD imposes a profound burden on patients, including medical emergencies and hospitalizations, work absenteeism and activity limitations. This, in turn, results in significant physical and emotional impact on patients.
- Dyspnea, or shortness of breath, associated with COPD caused significant activity restrictions, interfering with the everyday tasks most people take for granted: dressing, bathing, talking, and sleeping.
- Both doctors and patients agreed that the outlook for COPD has improved in recent years, and both recognized the benefits of treatment. Yet the symptoms and disease burden patients reported suggests that they are not achieving the level of treatment success that they believe is possible.
- Doctors and patients also agreed that there is a strong need for better education about COPD and the best ways to manage the disease.
The survey findings are particularly important because, despite the large and growing number of Americans affected by the disease, COPD, it has remained relatively invisible to the general public. As America ages, it will be increasingly important to understand one of the leading causes of death and disability among middle-aged and older Americans.
How the Survey Was Conducted
The survey was conducted between August 2 and November 21, 2000. Telephone interviews were completed with a national sample of 573 patients with COPD. The sample was identified by systematically screening a national sample of 26,880 US households to find people aged 45 and older who had been diagnosed with COPD, emphysema, or chronic bronchitis, or whose symptoms matched a strict definition of chronic bronchitis. A national sample of 203 physicians— 100 primary care physicians and 103 respiratory specialists— was also interviewed as part of the survey (Figure 1).
Confronting COPD in America was conducted by Schulman, Ronca, and Bucuvalas, Inc. (SRBI), a national public-opinion research firm. Dr. Stephen Rennard of the University of Nebraska Medical Center served as an advisor. The survey was funded by GlaxoSmithKline, one of the world's leading research-based pharmaceutical and healthcare companies.
