COPD Symptom Burden Linked to Work Impairment, Increased Utilization

A study of patients with chronic obstructive pulmonary disease (COPD) worldwide found that higher self-reported symptom burden was associated with more severe impairment of work and activities, as well as increased utilization of healthcare services.

Researchers identified COPD patients in 3 regions: China, the United States, and 5 European countries. The patients completed the COPD Assessment Test (CAT) to determine their symptom burden, and their physicians provided data on the patients’ COPD-related visits and exacerbations. The respondents from Europe and the US also answered a Work Productivity and Activity Impairment (WPAI) questionnaire. The results were published in the International Journal of Chronic Obstructive Pulmonary Disease.

Scores for the CAT ranged from 0 to 40, with a higher score indicating more severe symptom burden; almost two-thirds of respondents had a score of 20 or more. The researchers described how treatment patterns differed by score level, but also varied regionally. China, where the mean CAT score was the highest, had lower proportions of patients receiving maintenance triple combination therapy, for instance.

As the researchers had predicted, healthcare utilization was significantly associated with CAT score. The number of visits to both primary care physicians and pulmonologists was greater as CAT score increased. An increased number of exacerbations requiring emergency treatment or hospitalization was also associated with higher CAT scores.

More severe symptom burden was also linked to impairments in workplace productivity and activity. For each 10-point CAT score increase, absenteeism from work increased by 4.5 percentage points. Higher scores were also associated with increased levels of presenteeism, or time spent at work but impaired. Overall, the loss of work productivity, defined as absenteeism and presenteeism combined, was significantly associated with increased CAT scores, as was total activity impairment.

Prior research has identified associations between exacerbation frequency and utilization and impairment outcomes, but this was the first study to focus on the impact of symptom burden. According to the authors, these findings raise concerns about the quality of life among patients with severe COPD symptoms and may warrant more aggressive therapeutic interventions for this population.

“One quarter of the patients in our survey were actively employed and, therefore, their ability to manage their activity impairment in order to continue working is an important factor not only for financial reasons but also for maintaining a feeling of well-being, self-worth and a sense of contributing to society,” the authors wrote.