COURSE OF COPD

The Normal Course of COPD Is Punctuated By Increasing Frequency and Severity of Exacerbations

The Normal Course of COPD Is Punctuated By Increasing Frequency and Severity of Exacerbations

A. Discuss the significance of exacerbations of COPD in terms of the effects on patients and the health service.

With the global move towards patient-centred care, there is an increasing need for valid and reliable methods to assess patient values, concerns and preferences. Discrete choice modelling, which was developed from conjoint analysis, is widely used in economics to identify individual preferences, but has only recently been applied to healthcare settings. The technique provides an attribute-based measure of benefit, based on the suppositions that interventions, services, policies or events can be described by their attributes (characteristics), and that an individual's valuation depends on the levels (nature) of these attributes. (Gunen, 2005, 26234-241) As this technique is based on the belief that attributes considered jointly can be better measured than if considered individually, subjects are presented with a choice of scenarios that are described in terms of their attributes and associated levels. (Patrick, 1990, 33-41) For each choice, they are asked to choose their preferred outcome. The modelled data provide information on the importance of different attributes, the relative importance of levels, the rate at which respondents are willing to trade between levels and the overall benefit (utility) values for alternative scenarios. The feasibility of this type of approach has been demonstrated in asthma, where discrete choice modelling and conjoint analysis have been used to assess patient preferences for symptoms, type of treatment and delivery of services. However, to the current authors' knowledge, there have been no such studies in chronic obstructive pulmonary disease (COPD). (Gunen, 2005, 26234-241)

Exacerbations of COPD clearly have a dramatic impact on patient outcomes. However, there is considerable heterogeneity in the aetiology and manifestation of COPD exacerbations. A wide range of symptoms may be experienced, resulting in different physical and psychological consequences for individual patients. Improved understanding of the relative importance and desired outcomes of different attributes of COPD exacerbations from the patient's perspective may facilitate clinical management of this disorder. Although studies have shown that patients with COPD tend to underestimate the severity and impact of exacerbations patients' relative value judgments regarding how they feel about different aspects of exacerbations have not been extensively studied. With this in mind, the current studies used discrete choice modelling to describe, quantify and prioritise attributes associated with COPD exacerbations from the patients' perspective. (Patrick, 1990, 33-41)

Exacerbations of chronic obstructive pulmonary disease (COPD) have a negative effect on patients in terms of mortality, health related quality of life, and decline in lung function including huge socioeconomic costs on healthcare resources. Exacerbations commonly result in worsening of gas exchange and pulmonary aerodynamics, and are also predictive of admission to hospital. A British Thoracic Society audit of the hospital care of patients admitted for exacerbations of COPD revealed that 50% of them did not have a documented diagnosis of COPD, standard diagnostic investigations were often ...