title: Chronic obstructive pulmonary disease and exacerbations: patient insights from the global Hidden Depths of COPD survey.
abstract: BACKGROUND
  Although chronic obstructive pulmonary disease (COPD) is a major global health burden there is a lack of patient awareness of disease severity, particularly in relation to exacerbations.
  
  
  METHODS
  We conducted a global patient survey using an innovative, internet-based methodology to gain insight into patient perceptions of COPD and exacerbations in a real-world sample typical of today's working-age COPD population.
  
  
  RESULTS
  Two thousand patients with COPD (53%), chronic bronchitis (52%) and/or emphysema (22%) from 14 countries completed an online questionnaire developed by the authors. The Medical Research Council (MRC) breathlessness scale was used to delineate symptom severity. Over three quarters of patients (77%) had experienced an exacerbation, with 27% of MRC 1 and 2 patients and 52% of MRC 3, 4 and 5 patients requiring hospitalization as a result of an exacerbation. While a majority of MRC 1 and 2 patients (51%) reported being back to normal within a few days of an exacerbation, 23% of MRC 3, 4 and 5 patients took several weeks to return to normal and 6% never fully recovered. A high proportion of patients (39%) took a 'wait and see' approach to exacerbations.Despite the high prevalence of exacerbations and their negative impact on quality of life, 73% of MRC 1 and 2 patients and 64% of MRC 3, 4 and 5 patients felt that they had control of their COPD. However, 77% of all patients were worried about their long-term health, and 38% of MRC 1 and 2 patients and 59% of MRC 3, 4 and 5 patients feared premature death due to COPD.
  
  
  CONCLUSIONS
  To reduce the adverse effects of COPD on patients' quality of life and address their fears for the future, we need better patient education and improved prevention and treatment of exacerbations.
authors: Department of Respiratory Medicine, London Chest Hospital (Barts Health NHS Trust), Bonner Road, London E2 9JX, UK. neil.barnes@bartshealth.nhs.uk.
authors: Neil
authors: N
authors: Barnes
authors: Peter M A
authors: PM
authors: Calverley
authors: Alan
authors: A
authors: Kaplan
authors: Klaus F
authors: KF
authors: Rabe
mesh_terms: D015897:Comorbidity; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
references: Am J Respir Crit Care Med. 2001 Apr;163(5):1256-76
references: 11316667
references: Lancet. 2007 Sep 1;370(9589):741-50
references: 17765523
references: Thorax. 2010 Nov;65(11):956-62
references: 20871122
references: Respir Med. 2003 Mar;97 Suppl C:S3-14
references: 12647938
references: Respir Med. 2007 Mar;101(3):453-60
references: 16938447
references: Eur Respir J. 2004 Jun;23(6):932-46
references: 15219010
references: BMC Pulm Med. 2006 Nov 30;6 Suppl 1:S2
references: 17140420
references: Am J Respir Crit Care Med. 2004 Jun 15;169(12):1298-303
references: 14990395
references: Am J Med. 2009 Apr;122(4):348-55
references: 19332230
references: Respir Med. 2010 Feb;104(2):159-65
references: 19818590
references: Respir Res. 2010 Sep 10;11:122
references: 20831787
references: Eur Respir J. 2005 Oct;26(4):623-9
references: 16204592
references: Chest. 2006 Jul;130(1):133-42
references: 16840393
references: Am J Respir Crit Care Med. 2009 Mar 1;179(5):369-74
references: 19074596
references: J Med Internet Res. 2004 Sep 29;6(3):e34
references: 15471760
references: Eur Respir J. 2007 Mar;29(3):527-34
references: 17107990
references: Occup Med (Lond). 2008 May;58(3):226-7
references: 18441368
references: BMC Public Health. 2011 Aug 01;11:612
references: 21806798
references: Respir Med. 2002 Aug;96 Suppl C:S3-10
references: 12199489
references: Eur Respir J. 2008 Sep;32(3):796-803
references: 17989116
references: Am J Respir Crit Care Med. 2000 May;161(5):1608-13
references: 10806163
references: Thorax. 2004 Feb;59(2):120-5
references: 14760151
references: Am J Med. 2005 Dec;118(12):1415
references: 16378794
references: Eur Respir J. 2011 Mar;37(3):501-7
references: 20650988
references: Eur Respir J. 2002 Oct;20(4):799-805
references: 12412667