A cross-sectional assessment of the burden of COPD symptoms in the US and Europe using the National Health and Wellness Survey

Int J Chron Obstruct Pulmon Dis. 2017 Feb 7;12:529-539. doi: 10.2147/COPD.S114085. eCollection 2017.


Introduction: 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 and b =-0.67 and -0.79 in the 5EU, respectively; all P<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) (all P<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 (all P<0.05).

Conclusion: Patients with COPD who are using the appropriate SOC still experience symptoms, which have a significant effect on both humanistic and economic outcomes.

Keywords: COPD; adherence; health care resource use; quality of life; symptoms; work productivity.

Publication types

  • Multicenter Study

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Bronchodilator Agents / therapeutic use*
  • Cost of Illness*
  • Cough / drug therapy*
  • Cough / epidemiology
  • Cough / physiopathology
  • Cross-Sectional Studies
  • Dyspnea / drug therapy*
  • Dyspnea / epidemiology
  • Dyspnea / physiopathology
  • Efficiency
  • Europe / epidemiology
  • Exercise Tolerance
  • Female
  • Health Care Surveys
  • Health Resources / statistics & numerical data
  • Health Status
  • Humans
  • Lung / drug effects*
  • Lung / physiopathology
  • Male
  • Medication Adherence
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Quality of Life
  • Respiratory Sounds / drug effects*
  • Respiratory Sounds / physiopathology
  • Severity of Illness Index
  • Treatment Outcome
  • United States / epidemiology
  • Work Capacity Evaluation


  • Bronchodilator Agents