title: A two-year evaluation of the 'real life' impact of COPD on patients in Germany: The DACCORD observational study.
abstract: DACCORD is an observational, non-interventional study being conducted in German primary and secondary care centres. The study aims to describe the impact of disease (including exacerbations) and treatments over 2 years on 'real-life' patients with chronic obstructive pulmonary disease (COPD).
  
  
  
  Patients had a clinical and spirometry diagnosis of COPD, were aged ≥40 years and, on recruitment, were initiating or changing COPD maintenance medication. The only exclusion criteria were asthma and randomised clinical trial participation. Exacerbations data were collected every 3 months. COPD medication, COPD Assessment Test (CAT) and forced expiratory volume in 1 s (FEV1) were recorded at baseline and after 1 and 2 years.
  
  
  
  A total of 6122 patients were recruited, 3137 (51.2%) of whom completed the 2-year visit. The mean age of these patients was 65.6 years, 59% were male, 69% had mild or moderate airflow limitation, and their mean COPD Assessment Test (CAT) total score was 20.3. Overall, there was a trend towards decreasing COPD exacerbation rates over the 2-year follow-up period, with rates of 0.390 during Year 1 and 0.347 during Year 2. Rates were lower in patients with no exacerbation during the 6 months prior to entry (0.263 and 0.251 during Years 1 and 2, respectively), with 51.6% of patients having no exacerbation during the 6 months prior to entry and over the 2-year follow-up. Approximately 50% of the overall population experienced a clinically relevant improvement from baseline in CAT total score at Year 1 and 2. When assessed by treatment class (or classes), persistence to medication was high (77.8% in Year 1 and 71.4% in Year 2).
  
  
  
  Overall, the 2-year follow-up data from DACCORD suggest that for most patients with COPD exacerbations are a rare event. For the majority of patients, the focus should be on managing symptoms, and the impact that these symptoms have on their daily lives. Even for those patients who do exacerbate, although prevention of exacerbations is an important factor, management of symptoms should be a key consideration. DACCORD also suggests that COPD disease progression is not inevitable - providing patients are receiving pharmacological treatment.
authors.affiliation: Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, 60318 Frankfurt am Main, Germany. Electronic address: pkardos@aol.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Kardos
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL) 35043 Marburg, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Vogelmeier
authors.affiliation: Facharztforum Fürth, 90762 Fürth, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Worth
authors.affiliation: Pulmonary Department, Mainz University Hospital, 55131 Mainz, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Buhl
authors.affiliation: Novartis Pharma GmbH, D-90429 Nürnberg, Germany.
authors.forename: Nadine S
authors.initials: NS
authors.lastname: Lossi
authors.affiliation: Novartis Pharma GmbH, D-90429 Nürnberg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mailänder
authors.affiliation: Department of Sleep and Respiratory Medicine, Evangelical Hospital Göttingen-Weende, 37120 Bovenden, Germany.
authors.forename: Carl-Peter
authors.initials: CP
authors.lastname: Criée
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018450:Disease Progression; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D005858:Germany / Q000453:epidemiology; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D063868:Patient Outcome Assessment; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D057566:Self Report; D013147:Spirometry / Q000379:methods
keywords: CAT; COPD; Epidemiology; Exacerbations; Observational; Symptoms