Patients With COPD Prefer Improvement of Daily Symptoms Rather Than Exacerbations

A discrete choice experiment found that patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) valued improvement in their daily symptoms more than improvement of exacerbations.

A study published in ERJ Open Research found that patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) desired a reduction in cough and mucus production rather than improvement in shortness of breath (SOB) and also valued improvements in daily symptoms.

The study used the COPD Assessment Test (CAT), the Patient Activation Measure, the Cough and Sputum Assessment Questionnaire (CASA-Q), and the European Quality of Life Questionnaire along with questions on sociodemographic and clinical characteristics as a part of the survey. Data for the qualitative phase was collected from February to May 2019, and the quantitative data was collected from September to December 2019.

Patients were included in this study if they were aged 40 years and older, had a diagnosis of COPD, and had moderate-to-severe COPD defined as 1 or more COPD exacerbations in the previous year. Patients were excluded if they had done a COPD patients survey in the previous 3 months. Participation was voluntary for this survey.

All participants went through a profile-matching exercise to define “current” disease state and baseline profile. This was used to create a discrete choice experiment index. Severity of COPD was determined by either self-reported COPD severity, number of exacerbations in previous year, CAT score, and CASA-Q domain and overall scores.

There were 1050 participants for this study: 400 from the United States, 200 from the United Kingdom, 150 from France, 150 from Australia, and 150 from Japan. The population was slightly more male (51%) and 86% were current or former smokers. There were several reported comorbidities in the population, including asthma (44%), hypertension (40%), allergies (34%), and depression/anxiety (25%).

Nearly half of the population had experienced 2 or more exacerbations that led to hospitalization (47%) and 35% of the participants reported mucus when coughing in the previous 7 days.

The majority of participants selected the middle level of the 6 attributes as resembling their current state of health except in urinary incontinence where most patients selected the lowest level. Participants reported that more than half of them (54%) had urinary incontinence to some extent due to COPD (40% “COPD symptoms are causing a few drops of urine” and 14% “COPD symptoms are causing urine leakage which makes my underwear wet”).

Participants also reported that SOB was experienced during strenuous activity (30.8%), light activity (38.9%), when washing or dressing (25.8%), or at rest (4.6%).

Preference weights for improvements in cough and mucus combined had a higher change than those for SOB alone. A clear preference for cough and mucus improvement when compared with improvement of SOB alone. There was also a preference for daily symptom improvement compared with exacerbation improvement. The addition of any other symptom to mucus, cough, and SOB alleviation would increase the preference for daily symptom improvement.

Preferences were consistent when patients were separated by low, medium, and high severity. Cough symptoms and sputum symptoms scored the highest in the CASA-Q. There was no association between preferences and activation level of COPD, which is a score of how well a patient is maintaining their COPD diagnosis.

There were some limitations to this study. Discrete choice experiments were designed for independent attributes, which is difficult with COPD due to cough, mucus, and SOB being interconnected and deterioration of those symptoms links to exacerbations. The requirement of an online platform for participation may have excluded some participants. Study eligibility criteria was self-reported. Climate variability of the 5 countries where the study was conducted could influence the results.

The researchers concluded that people with moderate-to-severe COPD prefer a reduction in cough and mucus production over improvement in SOB and also prefer to reduce daily symptoms over improvement in exacerbations alone.

“Hence, there is clear value in symptom-focused therapies to deliver meaningful outcomes for people living with COPD,” the authors wrote.


Cook NS, Criner GJ, Burgel PR, et al. People living with moderate-to-severe COPD prefer improvement of daily symptoms over the improvement of exacerbations: a multicountry patient preference study. ERJ Open Res. 2022;8:00686-2021. doi:10.1183/23120541.00686-2021