Patient preferences in severe COPD and asthma: a comprehensive literature review.
BACKGROUND
Management of chronic incurable diseases such as chronic obstructive pulmonary disease (COPD) and asthma is difficult. Incorporation of patient preferences is widely encouraged.


OBJECTIVE
To summarize original research articles determining patient preference in moderate-to-severe disease.


METHODS
Acceptable articles consisted of original research determining preferences for any aspect of care in patients with COPD/asthma. The target population included those with severe disease; however, articles were accepted if they separated outcomes by severity or if the majority had at least moderate-to-severe disease. We also accepted simulation research based on scenarios describing situations involving moderate-to-severe disease that elicited preferences. Two reviewers searched Medline and Embase for articles published from the date of inception of the databases until the end of November 2014, with differences resolved through consensus discussion. Data were tabulated and analyzed descriptively.


RESULTS
About 478 articles identified, 448 were rejected and 30 analyzed. There were 25 on COPD and five on asthma. Themes identified as most important in COPD were symptom relief (dyspnea/breathlessness), a positive patient-physician relationship, quality-of-life impairments, and information availability. Patients strongly preferred sponsors' inhalers. At end-of-life, 69% preferred receiving CPR, 70% wanted noninvasive, and 58% invasive mechanical intervention. While patients with asthma preferred treatments that increased symptom-free days, they were willing to trade days without symptoms for a reduction in adverse events and greater convenience. Asthma patients were willing to pay for waking up once and not needing their inhaler over waking up once overnight and needing their inhaler.


CONCLUSIONS
Few studies have examined patient preference in these diseases. More research is needed to fill in knowledge gaps.
Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.
Basil G
BG
Bereza
Janssen A/S, Birkerød, Denmark.
Anders
A
Troelsgaard Nielsen
Janssen-Cilag A/S, Oslo, Norway.
Sverrir
S
Valgardsson
Janssen A/S, Birkerød, Denmark.
Michiel E H
ME
Hemels
Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.
Thomas R
TR
Einarson
D022126:Access to Information; D000203:Activities of Daily Living; D000280:Administration, Inhalation; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017281:Cost of Illness; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D009330:Nebulizers and Vaporizers; D057240:Patient Preference; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D012720:Severity of Illness Index; D013727:Terminal Care; D016896:Treatment Outcome
D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents
autonomy; convenience; end-of-life care; satisfaction; willingness-to-pay