No Breath Left: New Report Uncovers Under Reporting of "Lung Attacks" among Canadian COPD Patients Français
TORONTO, Feb. 21, 2012 /CNW/ - Drawing on findings from physician and patient research, a report released jointly today by COPD Canada and the Family Physician Airways Group of Canada highlights a critical finding when it comes to chronic obstructive pulmonary disease (COPD) care in Canada - the under reporting of flare-ups or "lung attacks" by COPD patients.
Despite the fact that "lung attacks" are the number one cause of hospital admissions among chronic illnesses1 and accelerate lung function decline2,3, more than half of Canadian COPD patients who were surveyed reported waiting to seek medical help4 and those patients taking no action was almost double the global average.5
The authors of the report "Breaking the Surface, Breaking the Silence", say there is an urgent need to do more to address the problem and reduce the number of "lung attacks" or "exacerbations" as they are described by physicians.
"The report is meant as a wake-up call for COPD patients and their physicians," says Dr. Kenneth Chapman, Medical Advisor, COPD Canada, Director of the Asthma and Airway Centre of the University Health Network, Professor of Medicine at the University of Toronto, and GSK-CIHR Research Chair in Respiratory Health Care. "If we can improve reporting and early treatment of "lung attacks", then we can reduce the length and severity of "lung attacks" and then take steps to prevent them. This will help put the brakes on a COPD patient's downward spiral."
According to the report, the patient perception is that flare-ups or "lung attacks" are "not as serious as heart attacks" even though studies have shown that patients admitted for a "lung attack" are more likely to die in the 12 months following hospital admission than patients admitted for a heart attack.6
"Patients and clinicians appropriately fear a heart attack, but the likelihood of dying after being hospitalized with a lung attack is more than twice as high," says Dr. Alan Kaplan, Chairperson of the Family Physician Airways Group of Canada.
Mary Layton, who was diagnosed with COPD in 1993 and is the Founder of COPD Canada, says the report also highlights what is so challenging for many patients - the impact of the disease and "lung attacks" on quality-of-life. "COPD can leave you incapable of doing so many day-to-day activities like climbing stairs, walking, brushing your teeth and even getting dressed. And because many patients often experience excessive coughing in public, there are feelings of embarrassment, so they often find themselves spending more and more time alone."
What is a flare-up or "lung attack"?
COPD is a debilitating and degenerative lung disease which makes it difficult to breathe. A flare-up or "lung attack" is a worsening of symptoms, including cough, increase in shortness of breath and mucus production and can be caused by exposure to the common cold, flu, pneumonia or air pollution.7, 8 While respiratory infections are more frequent during the winter7, a person with COPD continues to be at-risk for "lung attacks" throughout the year.2,9
Costs to the healthcare system
Once someone is admitted to a hospital for a "lung attack", they will spend an average of 10 days, with an average of $10,000 per stay.10 In fact, "lung attacks" are responsible for significant hospitalization costs - conservatively estimated at $1.5 billion a year.10 Adding to this evidence, the report cites that Canadian COPD patients are well below the global average (55% versus 73%) for accessing healthcare services in response to a "lung attack", but above average for relying on the emergency room when they do seek care.11
Identified gaps which lead to under reporting of "lung attacks" in Canada
While the report suggests that most patients are well informed about their disease and physicians are playing an active role in COPD disease management, problems still exist between the two groups when it comes to "lung attacks".
The authors explain, there are a number of gaps between physicians and patients that are contributing to communication challenges including:
- There is a lack of a common language between physicians and patients when it comes to describing the definition and severity of a "lung attack". Many patients don't completely understand the definition of a "lung attack". Many confuse "lung attacks" with periodic attacks of breathlessness.
- Many patients perceive only the immediate functional impact of a "lung attack". They don't understand the impact on disease progression and how their treating physicians need to know the "full picture" in order to properly manage their COPD.
- Many Canadian COPD patients delay seeking care for a "lung attack. Many wait until the last minute before going to the ER, as opposed to presenting earlier during their attack to their treating physician.
- Smoking cessation is the key component in COPD management, yet is an emotionally-loaded issue between patients and physicians with some patients reporting some doctors as "judgmental" if they still smoked.
Report recommendations
Addressing the under reporting of "lung attacks" represents a crucial opportunity to improve COPD patient outcomes. The report makes three major recommendations:
Improved identification of "lung attacks":
Patients need to understand the importance of reporting all "lung attacks", even mild attacks such as chest colds, to their treating physician. GPs and patients need to work collaboratively, using common language to identify those 'sick days' or 'bad days' which last longer than 48 hours12, as they are not just an inconvenience, but a clinically important "lung attack".
Prevention and management:
Physicians need:
- to emphasize the importance of preventing "lung attacks", including the short and long term impact of repeated attacks on a patient's disease progression and their quality-of- life.
- to provide patient education on how to avoid "lung attacks" through regular flu shots, pneumonia shots, handwashing, minimizing exposure to those who have colds/flu and optimal medication.
- to underscore the urgency of seeking prompt medical care in the event of a "lung attack" and equip patients with a self-management plan (www.COPDactionplan.com), so that if they recognize symptoms of a "lung attack", they can act accordingly.
Smoking cessation:
Smoking cessation discussions need to be conducted in a mutually constructive manner, with GPs embracing an addiction control approach, which could be of value in encouraging patients to communicate more freely with their physicians.
Earlier identification of at-risk patients and more effective management and prevention of "lung attacks" would help ease the burden of COPD on the Canadian medical system and on patients' lives.
To access your copy of "Breaking the Surface, Breaking the Silence: How the under-reporting of "lung attacks" in Canada impacts patient outcomes in COPD", or for more information, please visit COPD Canada at www.copdcanada.info or the Family Physicians Airways Group of Canada at www.fpagc.com .
About COPD13,14
COPD is a respiratory disease that causes lung damage and airway obstruction (blocks the airways) and is sometimes called chronic bronchitis and/or emphysema. COPD is primarily caused by smoking. It is the fourth leading cause of death in Canada, and research from the Lung Association shows that three million Canadians may have COPD.
About COPD Canada
COPD Canada is an independently registered non-profit organization that was established in 2005. The organization's primary mandate is to assist Canadians who suffer from COPD.
At its core, COPD Canada is an educational association and patient advocacy group. The organization is involved in providing patient education materials and services, in a variety of formats, using different delivery methodologies. We also develop, sponsor and produce quality-of-life seminars for patients and their families as well as continuing education seminars for healthcare professionals.
About The Family Physicians Airways Group of Canada
The Family Physicians Airways Group of Canada is committed to helping those with airway diseases lead a full life. The group is dedicated to helping all family physicians maintain and increase their skill in assisting those with asthma and COPD. The strategy of the Group is to maintain a speaker bank, a data bank, and practical tools to help physicians attain these skills.
About this report
The report was made possible through the support of Nycomed: A Takeda Company.
Methods: Two round-table discussions with respiratory specialists, general practitioners and COPD patients were conducted in October 2010. These research groups were complemented by a global opinion study, the "Hidden Depths of COPD", which highlighted care and communication gaps among COPD patients and physicians in Canada and 13 other countries worldwide.
References
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4 The Hidden Depths of COPD Survey. September 2010. What are the main reasons you seek medical attention or advice if you are experiencing one of these attacks?
5 The Hidden Depths of COPD Survey. September 2010. Which, if any of the following do you typically do if you experience one of these attacks? Global vs Canada.
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7 Taylor JD, Wreggett, KA, Olsson H et al. Latest therapies targeting exacerbations in COPD. Drug Discovery Today: Therapeutic Strategies 2008, 5(2): 101-110.
8 The Lung Association, COPD Flare-Ups: What To Do Available at: http://www.lung.ca/diseases-maladies/copd-mpoc/flareups-pousseesactives/index_e.php
Accessed March 5, 2011.
9 Health Fact Sheet - Seasonal variation in COPD. Met Office, UK. Available at: http://www.metoffice.gov.uk/media/pdf/9/0/Seasonal_variation_in_COPD.pdf. Accessed on January 13, 2012.
10 Mittman, N, Kuramoto L, Seung SJ et al. The cost of moderate and severe COPD exacerbations to the Canadian healthcare system. Respiratory Medicine. 2008;102(3): 413-421.
11 The Hidden Depths of COPD Survey. September 2010. Which, if any of the following do you typically do if you experience one of these attacks? Canada.
12 O'Donnell D et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2007 update. Can Respir J 2007, 14 (Suppl B):5B-32B.
13WHO. Chronic obstructive pulmonary disease (COPD). Available at: http://www.who.int/respiratory/copd/en Accessed March 5, 2011.
14The Lung Association. COPD in Canada. Available at: http://www.lung.ca/_resources/COPD_in_Canada_CLA_2007.pdf Accessed March 3, 2011.
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