| 1. What is a COPD exacerbation? |
Exacerbations
are important clinical events in COPD and impose an extremely high
economic and social burden (GOLD, 2003).
An exacerbation is defined as a deterioration in a patient’s
clinical status, with worsening of respiratory symptoms, such as
coughing, wheezing, sputum production and shortness of breath.
Exacerbations may require medical intervention, which means that they
are severe enough to warrant use of oral steroids or treatment with
antibiotics, or even hospitalisation.
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| 2. How do exacerbations impact on health-related quality of life |
How
do exacerbations impact on health-related quality of life?
Along
with the physical deterioration, exacerbations have a major impact on
patients’ feelings of well-being and health-related quality of
life (Donaldson GC, et al 2002) and
are extremely distressing for patients and their families. As the
disease worsens, patients find it increasingly difficult to perform
even the activities of everyday living, like getting washed and
dressed and walking up stairs. Patients who have exacerbations more
frequently have a worse health-related quality of life.
(Seemungal TAR et al,1998.)
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| 3. To what extent does Symbicort reduce exacerbations? |
Symbicort
is the only inhaled steroid/long-acting bronchodilator combination
shown to reduce exacerbations versus a long-acting bronchodilator
alone. Symbicort has been shown to extend
the time to first severe exacerbation by 158 days more than placebo,
100 days more than formoterol alone, and 76 days more than budesonide
alone. (Calverley et al, 2003) This reduction in exacerbations
provides a significant improvement in COPD patients' quality of
life, and helps to give patients the confidence to return to everyday
activities. Symbicort also reduced the risk of a first exacerbation
by 29% vs placebo, 30% vs formoterol (both p<0.01) and 23% vs
budesonide (p<0.05). In both the Szafanski and Calverley study the
frequency of exacerbations was reduced by 24% vs placebo and by 22%
and 27% respectively vs formoterol. (Szafranski et al, 2003)
Calverley study summary
Szafranski study summary
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