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Comorbidities, Patient Knowledge, and Disease Management in a National Sample of Patients with COPD

Comorbidities are common in chronic obstructive pulmonary disease (COPD) and likely add to the complexity and cost of care. Patient self-knowledge about COPD is lower than for cardiovascular comorbidities. COPD is undertreated compared with generally asymptomatic, less morbid conditions such as hypertension.

Abstract

Objective
COPD is the fourth leading cause of death in the United States but is often undertreated. COPD often overlaps with other conditions such as hypertension and osteoporosis, which are less morbid but may be treated more aggressively. We evaluated the prevalence of these comorbid conditions and compared testing, patient knowledge, and management in a national sample of patients with COPD.

Methods
A survey was administered by telephone in 2006 to 1003 patients with COPD to evaluate the prevalence of comorbid conditions, diagnostic testing, knowledge, and management using standardized instruments. The completion rate was 87%.

Results
Among 1003 patients with COPD, 61% reported moderate or severe dyspnea and 41% reported a prior hospitalization for COPD. The most prevalent comorbid diagnoses were hypertension (55%), hypercholesterolemia (52%), depression (37%), cataracts (31%), and osteoporosis (28%). Only 10% of respondents knew their forced expiratory volume in 1 second (95% confidence interval [CI], 8-12) compared with 79% who knew their blood pressure (95% CI, 76-83). Seventy-two percent (95% CI, 69-75) reported taking any medication for COPD, usually a short-acting bronchodilator, whereas 87% (95% CI, 84-90) of patients with COPD and hypertension were taking an antihypertensive medication and 72% (95% CI, 68-75) of patients with COPD and hypercholesterolemia were taking a statin.

Conclusion
Although most patients with COPD in this national sample were symptomatic and many had been hospitalized for COPD, COPD self-knowledge was low and COPD was undertreated compared with generally asymptomatic, less morbid conditions such as hypertension.

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— R. Graham Barr, MD, DrPH, Bartolome R. Celli, MD, David M. Mannino, MD, Thomas Petty, MD, Stephen I. Rennard, MD, Frank C. Sciurba, MD, James K. Stoller, MD, MS, Byron M. Thomashow, MD, Gerard M. Turino, MD

This article was originally published in the April 2009 issue of The American Journal of Medicine.

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