COPD: Therapy Should Focus on Patient's Quality of Life

When chronic obstructive pulmonary disease (COPD) is managed with a focus on how the symptoms impact the patient, quality of life and outcomes can be improved, UK researchers found..

Exercise training, behavior modification, and education delivered by a multidisciplinary team, and in some cases pulmonary rehabilitation, can be helpful. Such interventions should be as carefully considered and tailored to individual patients as drug dosages, Paul W. Jones and colleagues wrote in the International Journal of Chronic Obstructive Pulmonary Disease on February 19, 2016.

Jones of the Division of Clinical Science, St. George’s, at the University of London, and colleagues reviewed information presented at the 1st World Lung Disease Summit. The meeting was held in Lisbon, Portugal November 15-17, 2013.

Although the symptoms of COPD are well-documented, the degree to which they limit a patient’s quality of life (QoL) “varies depending on a number of factors, for example, their disease severity and comorbidities” say the researchers.

Additionally, the time of day that the patient experiences symptoms affects QoL.

There are several instruments available for clinicians to evaluate patients’ symptoms: the COPD Assessment Test (CAT), the Clinical COPD Questionnaire (CCQ), the modified Medical REsearch Council dyspnea score (mMRC), and the St. George’s Respiratory Questionnaire SGRQ, as well as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system.

Patients with COPD are progressively less active. A decline in physical activity usually begins early in the disease.

The reviewers reported that one study concluded, “the objective measurement of physical activity is the strongest predictor of all-cause mortality in patients.” In light of those findings, the researchers say, “an appropriate level of physical activity is very important in patients with COPD, as it plays a key role in maintaining health.”

COPD, like other chronic conditions, is often accompanied by comorbidities which impact COPD symptoms and QoL. The reviewers say, “Comorbidities make COPD management more challenging and increase the use of health care services.” Identifying common comorbidity clusters could help in the management of COPD.

Optimizing both the time and method of delivery of bronchodilators, the “mainstay of therapy in COPD” according to researchers, can help improve exercise tolerance and improve levels of physical activity.