title: A cross-sectional assessment of the burden of COPD symptoms in the US and Europe using the National Health and Wellness Survey.
abstract: BACKGROUND
  Past research has suggested significant relationships between symptoms and health outcomes among patients with COPD. However, these studies have generally focused on a broad COPD sample and may have included those not receiving proper treatment. As a result, the aim of this study was to document the burden of COPD symptoms among those who are currently treated with the standard-of-care (SOC) medications in both the US and Western Europe.
  
  
  METHODS
  Data from the 2013 US (N=75,000) and 2011 (N=57,512)/2013 (N=62,000) European (France, Germany, Italy, Spain, and UK; 5EU) National Health and Wellness Survey (NHWS) were used. The NHWS is a health survey administered to a demographically representative sample of the adult population in each country. A total of 1,666 and 2,006 patients with self-reported physician diagnosis of COPD in the 5EU and US, respectively, were being treated with the appropriate SOC (based on self-reported medication use) and were included in the analyses. Symptoms (eg, dyspnea, coughing, wheezing) were reported descriptively and summed to create a symptom score (with higher score indicating more frequent symptoms). The relationships between the symptom score and patient outcomes (eg, health status using the Short Form-36 version 2 [SF-36v2], work productivity and activity impairment [WPAI], and self-reported health care resource use) were explored using regression modeling.
  
  
  RESULTS
  Nearly all patients (99.7% and 99.8% in the 5EU and US, respectively) reported experiencing symptoms and >80% reported experiencing at least one symptom "often". Increasing symptom scores were associated with poorer health status (unstandardized beta [b] =-0.87 and -0.78 for mental component summary and physical component summary, respectively, in the US andb=-0.67 and -0.79 in the 5EU, respectively; allP<0.05). Increasing symptom scores were also associated with greater work impairment (b=0.09 and 0.06 for the US and 5EU, respectively), activity impairment (b=0.05 and 0.06, respectively), and health care resource utilization (eg, hospitalizations:b=0.05 and 0.06, respectively) (allP<0.05). Approximately 70% of patients reported some level of non-adherence. Greater non-adherence was significantly associated with more frequent symptoms, poorer health status, and greater work impairment and health care resource use (allP<0.05).
  
  
  CONCLUSIONS
  Patients with COPD who are using the appropriate SOC still experience symptoms, which have a significant effect on both humanistic and economic outcomes.
authors.affiliation: AstraZeneca Gothenburg, Mölndal, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Ding
authors.affiliation: Kantar Health, New York, NY, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: DiBonaventura
authors.affiliation: AstraZeneca Gothenburg, Mölndal, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Karlsson
authors.affiliation: AstraZeneca Gothenburg, Mölndal, Sweden.
authors.forename: Gina
authors.initials: G
authors.lastname: Bergström
authors.affiliation: AstraZeneca Gothenburg, Mölndal, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Holmgren
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D017281:Cost of Illness; D003371:Cough / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D004526:Efficiency; D005060:Europe / Q000453:epidemiology; D017079:Exercise Tolerance; D005260:Female; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D011788:Quality of Life; D012135:Respiratory Sounds / Q000187:drug effects* / Q000503:physiopathology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014938:Work Capacity Evaluation
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; adherence; health care resource use; quality of life; symptoms; work productivity