UCL Respiratory, University College London, London, UK.
HEOR and RWE Analytics, Regulatory Access, Parexel International Ltd, Mohali, India.
Int J Chron Obstruct Pulmon Dis. 2021 May 10;16:1303-1314. doi: 10.2147/COPD.S296696. eCollection 2021.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, causing substantial economic and social burden.
This review assessed the patient-reported humanistic burden associated with moderate to very severe COPD, specifically the impact on health-related quality of life (HRQoL), symptoms, limitations in daily life, and emotional implications, through the use of HRQoL instruments.
A systematic review was conducted to retrieve relevant clinical data from published literature using a representative sample of countries where healthcare systems provide wide availability of COPD medications and/or universal coverage includes respiratory medicines (Australia, Canada, China, France, Germany, Italy, Spain, the UK, and the USA). The primary inclusion criteria were patients with moderate to very severe COPD. HRQoL was quantified with non-disease-specific and disease-specific questionnaires.
In total, 82 studies from 95 publications presented HRQoL data from patients with moderate to very severe COPD. Patient-reported HRQoL declined with worsening airflow limitation, advancing GOLD group, and increasing exacerbation frequency. Both increasing frequency of hospitalization for COPD exacerbations and recurrent hospitalization adversely impacted HRQoL. Comorbidity incidence was higher in patients with increased airflow limitation. It was associated with a further decline in HRQoL and increased depression and anxiety, particularly as disease-associated pain worsened. Physical activity improved HRQoL over time.
This review highlighted the impact of exacerbations and associated hospitalizations on the humanistic burden of COPD. These findings underline the importance of managing COPD actively, including prompt and appropriate use of pharmacological and non-pharmacological therapies that can improve symptoms and reduce the risk of exacerbations, thereby lessening the humanistic burden. Future reviews could consider a broader range of countries and publications to further assess the humanistic impact of COPD in low- and middle-income economies.
慢性阻塞性肺疾病（COPD）是全球发病率和死亡率的主要原因，给经济和社会带来了巨大负担。
本综述评估了中重度至极重度 COPD 患者报告的人文负担，特别是通过健康相关生活质量（HRQoL）工具评估其对生活质量、症状、日常生活受限和情绪影响的影响。
系统检索了来自发表文献的相关临床数据，代表了医疗保健系统广泛提供 COPD 药物和/或包括呼吸药物在内的全民覆盖的国家（澳大利亚、加拿大、中国、法国、德国、意大利、西班牙、英国和美国）。主要纳入标准为中重度至极重度 COPD 患者。使用非疾病特异性和疾病特异性问卷评估 HRQoL。
共有 82 项来自 95 项出版物的研究报告了中重度至极重度 COPD 患者的 HRQoL 数据。患者报告的 HRQoL 随气流受限恶化、GOLD 组进展和加重频率增加而下降。COPD 加重住院频率增加和反复住院均对 HRQoL 产生不利影响。随着气流受限的增加，合并症的发生率更高。它与 HRQoL 的进一步下降以及抑郁和焦虑的增加有关，特别是当疾病相关疼痛加重时。身体活动随时间推移改善了 HRQoL。
本综述强调了加重和相关住院对 COPD 人文负担的影响。这些发现强调了积极管理 COPD 的重要性，包括及时和适当使用药物和非药物治疗，可以改善症状，降低加重风险，从而减轻人文负担。未来的综述可以考虑更广泛的国家和出版物，以进一步评估 COPD 在中低收入经济体中的人文影响。
