Regional perceptions of exacerbations by people living with COPD: A mixed methods survey conducted in Brazil, China, Europe and the USA

Introduction: Clear and accurate communication between patients and healthcare providers (HCPs) is key to identifying exacerbations of COPD and improving patients’ outcomes. We conducted a patient survey to understand: (1) how individuals living with COPD recognise exacerbations; (2) the wording and terms they preferably use; (3) the emotions associated with experiencing an exacerbation. Methods: A survey consisting of 26 multiple-choice questions was developed using a targeted literature review and further informed by patients and subject matter experts. People living with COPD were recruited from consumer panels in four regions – Brazil, China, Europe (France, Spain, UK) and the USA – and responded to the survey online. Responses to questions were described by region for people with a history of exacerbations. Results: Out of 857 respondents, 671 (78%) reported having had an exacerbation (Table 1). Across all regions except China, <20% of individuals relied on their HCP to identify exacerbations. Instead, these were mostly identified as events when symptoms are ‘worse than usual’ (46% and 66% of individuals, respectively, in Europe and China) and by their impact on daily activities. Plain language is preferably used by patients across countries: ‘COPD attack’ in China (58%), ‘crisis’ in Brazil (62%), or ‘feeling worse than usual’ or ‘flare-up’ in the USA (both 36%), and ‘feeling worse than usual’ in Europe (42%). The term ‘exacerbation’ was used by 7% (Brazil) to 37% (China) of survey respondents. Strong emotions are associated with exacerbations: feeling ‘worried’ was experienced by 56%, 66% and 67% of individuals in Europe, China and Brazil, respectively. In the USA, individuals’ most frequent emotion was feeling ‘frustrated’. Discussion: This multi-country patient survey highlights the importance of HCPs using plain language when discussing COPD exacerbations with patients. Using emotion-related terms may further support patients in identifying and managing these acute events.