Patients dislike hospital admission more than worsening symptoms in exacerbations of COPD

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Exacerbations of COPD - an acute worsening of symptoms, often triggered by a respiratory infection, requiring medical intervention and often hospitalisation - are extremely distressing for patients with this condition and their families.
But what features of exacerbations do patients with COPD consider most important and most distressing?



In this study, undertaken by John Haughney (University of Aberdeen, UK) and his European colleagues, 125 patients from five countries with recurring exacerbations of COPD were interviewed face-to-face. This study was the first of its kind to use discrete-choice modelling in COPD.


Discrete-choice modelling is a powerful tool, which, through forcing choice, allows measurement of the relative importance of different features of a scenario, in this case exacerbations of COPD. It has been used widely in commercial situations and a number of studies have now been reported in the medical literature.



Contrary to a popularly held belief that symptom control is the main aim of treatment, the authors report that the feature that most patients with COPD desire at the time of an exacerbation is not to be housebound, and, in particular, not to be admitted to hospital.


These features ranked as more important than relief of breathlessness, cough and speed of recovery.



The authors conclude that clinicians should focus their efforts on minimising the frequency and severity of exacerbations; the relief of symptoms, such as breathlessness and cough, is not enough.



The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 7,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).

European Respiratory Journal