Chronic Obstructive Pulmonary Disease Individualized Therapy: Tailored Approach to Symptom Management

Abstract

Chronic obstructive pulmonary disease (COPD) is associated with high morbidity and mortality. COPD is typified by persistent, progressive airflow limitation and a range of respiratory and systemic symptoms such as breathlessness, coughing, wheezing, depression, anxiety, general fatigue, and sleeping difficulties. Despite receiving treatment for COPD, many patients suffer from regular symptoms that affect their daily lives and lead to increased morbidity. These symptoms vary in severity, frequency, and type, and can occur at any time throughout the 24-h day, with over half of patients with COPD experiencing symptoms in the morning, during the day, and at nighttime. Despite the prevalence of symptoms, patient and physician perception of the impact of COPD symptoms on patients’ lives is not always in concordance. Dual bronchodilator therapy with a long-acting muscarinic antagonist (LAMA) and long-acting beta agonist (LABA) has the potential to treat the symptoms of COPD in addition to improving lung function. This review therefore examines the burden of symptoms experienced throughout the day by patients with COPD and the evidence for combined LAMA/LABA treatment in terms of symptom management. As patients with COPD experience varying symptoms throughout the course of their disease, the role of tailoring treatment to the individual needs of the patient is also examined. We conclude that the symptoms of COPD are troublesome, variable, can occur during all parts of the 24-h day, and have a substantial impact on patients’ health status and quality of life. In order to provide effective, patient-orientated care, patients with COPD should be evaluated on the basis of lung function, the frequency of symptoms, and patient-perceived impact of symptoms on their lives. Therapy should be chosen carefully based on individualized assessment, ensuring personalization to the individual needs of the patient.

The revised GOLD 2017 COPD categorization in relation to comorbidities

“…Symptoms and exacerbation history were defined in accordance with the revised GOLD recommendations, which suggest that either CAT or mMRC can be used to assess the impact of symptoms [13]. However, there are data suggesting that CAT and mMRC might not be equivalent [10,11], and we therefore performed analyses for both.…”

Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

“…However, the data reviewed herein provide information to identify patient groups that may benefit from ICS use (Figure 2). Concerns with ICS use are related to the safety considerations described in the previous section and the potential risks associated with withdrawal of ICS therapy 45,74,78. Long-term adverse events described in some studies are complicated by concomitant oral CS use and confounding disease severity, as well as comorbidities.…”

Symptomatic burden of COPD for patients receiving dual or triple therapy

“…21 Our results on the prevalence of daytime/nighttime symptoms, breathlessness being the most common symptom, prevalence of sleep impairment, and more than half of patients being dissatisfied with their current medications' ability to control symptoms were in general agreement with previous studies. 4,17 Previous studies have reported that concordance of symptom burden and impact on HRQOL reports from physicians and patients are greater for patients with more severe COPD compared with those with milder disease. 21 In our study, there was reasonable concordance between physician-and patient-reported responses describing symptom burden, suggesting that physician-patient communication is not a barrier to improving care for patients with more severe disease, although it may be a factor for those with milder disease.…”