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Chronic obstructive pulmonary disease and exacerbations: Patient insights from the global Hidden Depths of COPD survey

Neil Barnes1*, Peter MA Calverley2, Alan Kaplan3 and Klaus F Rabe4

Author Affiliations

1 Department of Respiratory Medicine, London Chest Hospital (Barts Health NHS Trust), Bonner Road, London E2 9JX, UK

2 Division of Infection and Immunity, Clinical Sciences Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK

3 Canada and Bedford Park Family Medical Centre, University of Toronto, 17 Bedford Park Avenue, Richmond Hill, Ontario L4C 2N9, Canada

4 Department of Medicine, Germany and LungenClinic Grosshansdorf, members of the German Center for Lung Research, University Kiel, D-22927, Grosshansdorf, Germany

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BMC Pulmonary Medicine 2013, 13:54  doi:10.1186/1471-2466-13-54

Published: 23 August 2013



Although chronic obstructive pulmonary disease (COPD) is a major global health burden there is a lack of patient awareness of disease severity, particularly in relation to exacerbations.


We conducted a global patient survey using an innovative, internet-based methodology to gain insight into patient perceptions of COPD and exacerbations in a real-world sample typical of today’s working-age COPD population.


Two thousand patients with COPD (53%), chronic bronchitis (52%) and/or emphysema (22%) from 14 countries completed an online questionnaire developed by the authors. The Medical Research Council (MRC) breathlessness scale was used to delineate symptom severity. Over three quarters of patients (77%) had experienced an exacerbation, with 27% of MRC 1 and 2 patients and 52% of MRC 3, 4 and 5 patients requiring hospitalization as a result of an exacerbation. While a majority of MRC 1 and 2 patients (51%) reported being back to normal within a few days of an exacerbation, 23% of MRC 3, 4 and 5 patients took several weeks to return to normal and 6% never fully recovered. A high proportion of patients (39%) took a ‘wait and see’ approach to exacerbations.

Despite the high prevalence of exacerbations and their negative impact on quality of life, 73% of MRC 1 and 2 patients and 64% of MRC 3, 4 and 5 patients felt that they had control of their COPD. However, 77% of all patients were worried about their long-term health, and 38% of MRC 1 and 2 patients and 59% of MRC 3, 4 and 5 patients feared premature death due to COPD.


To reduce the adverse effects of COPD on patients’ quality of life and address their fears for the future, we need better patient education and improved prevention and treatment of exacerbations.

COPD; Exacerbation; Patient-reported; Survey