Although there is no cure for COPD, there are treatment plans that involve stopping smoking that can provide symptom relief and help slow the progression of the disease. Confronting COPD in America offers insight into patient and physician attitudes about COPD management.

Patients and Physicians Are Optimistic About Treatment

Although two out of three patients with COPD (66 percent) recognized that COPD tended to get worse with age, they also recognized that proper treatment had significant benefits:

• 80 percent believed that it is possible to slow the progressive breathlessness of COPD

• 78 percent believed that there is better control of COPD than there was five years ago

• 74 percent believed that with proper treatment, patients can lead a full and active life

Doctors were also optimistic about treatment. Three out of four (76 percent) felt that the long-term health outlook for people with COPD was better at the time of the study than it was 10 years ago, and 78 percent of the physicians who felt this way credited better medications.

What Physicians Prescribe

Doctors most often rated bronchodilators (40 percent) and inhaled corticosteroids (35 percent) as very effective in the treatment of mild to moderate COPD. The role of these anti-inflammatory medications in COPD therapy is not well defined, and they are not yet approved for COPD in the United States. However, clinical trials are underway. Nine out of 10 said bronchodilators and inhaled corticosteroids were somewhat effective for mild to moderate COPD; about half said this about mucolytics and antibiotics.

Substantial proportions of physicians said that they would normally prescribe the following medications to "all or most" of their newly diagnosed patients:

• Short-acting beta₂-agonists (66 percent)

• Inhaled corticosteroids (64 percent)

• Anticholinergics (48 percent)

• Long-acting beta₂-agonists (47 percent)

Much smaller proportions of doctors said they would normally prescribe other medications— leukotriene modifiers, theophylline, oral corticosteroids, or prophylactic antibiotics— to all or most newly diagnosed patients with moderate COPD.

What Patients Take

Only 61 percent of patients with COPD reported that they were taking any prescription medicine for their condition at the time of the survey. Another 17 percent said they had taken prescription medicines for COPD in the past year, but not at the time of the survey.

The percentage of people with COPD who reported taking specific types of prescription medicines for their condition was substantially less than the proportion of physicians who said they would prescribe these medications for moderate COPD. One notable disparity: while approximately the same proportion of physicians said they would recommend long-acting beta₂-agonists (47 percent) as often as anticholinergics (48 percent), substantially fewer patients reported taking long-acting beta₂-agonists (7 percent) than anticholinergics (19 percent) in the past year.

A Treatment Burden?

The survey suggested that, in addition to the disease burden of COPD, patients also perceived that their medications presented a "treatment burden":

• 31 percent felt their medication schedule made it difficult to lead an active life

• 62 percent said that taking so many medicines was inconvenient

• 57 percent said they would be better about taking medicine if it were more convenient

• 89 percent agreed that twice-a-day dosage was more convenient than 3-4 times a day

Also, nine out of 10 patients said they wanted a medication that allowed normal activity levels. Despite this desire and the belief that proper treatment can make it possible to lead a full and active life, many patients reported that they were living with serious activity restrictions.

A Need For Better Education About COPD Management

The survey points to what appears to be a significant shortcoming in COPD management. Though most patients said that proper treatment could make it possible to lead a full and active life, the high disease burden revealed by the survey suggests that patients might not be living up to their own expectations.

One explanation might be that patients did not completely understand the best ways to manage their condition. The survey found that whereas 71 percent of patients said they "completely" or "mostly" understood how to manage their COPD, only 44 percent of physicians said this of their patients. In addition, 76 percent of patients and 71 percent of physicians said there is "strong need" for patient education about COPD management.