Late Breaking Abstract - Silent exacerbations: underreporting of COPD exacerbations in Poland

Abstract

Background: Accurate assessment of exacerbation frequency in chronic obstructive pulmonary disease (COPD) is key for optimal maintenance therapy and estimating long-term prognosis. However, patients9 understanding of the disease may affect the reporting and management of COPD exacerbations. Objective: to assess consistencies in physicians9 and patients9 perspectives of COPD treatment goals and management of exacerbations. Methods: 30 direct interviews with pulmonologists in open care, treating > 14 COPD patients per week; 101 paper-and-pen personal interviews (PAPI) with COPD patients (recruited by pulmonologists), collected in Jan-Feb 2020. Definition of exacerbation was in line with the GOLD 2020 guidelines. Results: The key COPD treatment goals stated by pulmonologists were: prevention of exacerbations (83%), maintenance of lung function status (83%), improvement of patients9 functioning in everyday life (57%). The key treatment goals indicated by patients were: breathlessness reduction (71%), improvement of functioning in everyday life (65%) and reduction of exacerbations (59%). In total, 68% of patients experienced an exacerbation in the past 12 months (5.2/year), and 2.8 of them have been treated at-home, without reporting. Only 2.4 out of 5.2 exacerbations (46%) were treated under physician guidance and noted in the patient file. Conclusions: Physicians9 and patients9 COPD treatment goals differ, and only two out of every five exacerbations are the subject of medical consultation. Indeed, over 50% represent silent exacerbations, which are not reported by patients. A lack of patients awareness of the importance of these exacerbations may explain underreporting, resulting in suboptimal treatment.