Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • COVID-19 submission information
    • Peer reviewer login
  • Alerts
  • Podcasts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • COVID-19 submission information
    • Peer reviewer login
  • Alerts
  • Podcasts
  • Subscriptions

A systematic review of how patients value COPD outcomes

Yuan Zhang, Rebecca L. Morgan, Pablo Alonso-Coello, Wojtek Wiercioch, Małgorzata M. Bała, Rafał R. Jaeschke, Krzysztof Styczeń, Hector Pardo-Hernandez, Anna Selva, Housne Ara Begum, Gian Paolo Morgano, Marcin Waligóra, Arnav Agarwal, Matthew Ventresca, Karolina Strzebońska, Mateusz T. Wasylewski, Lídia Blanco-Silvente, Janna-Lina Kerth, Mengxiao Wang, Yuqing Zhang, Saiprasad Narsingam, Yutong Fei, Gordon Guyatt, Holger J. Schünemann
European Respiratory Journal 2018 52: 1800222; DOI: 10.1183/13993003.00222-2018
Yuan Zhang
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rebecca L. Morgan
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Pablo Alonso-Coello
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
2Iberoamerican Cochrane Centre, CIBERESP-IIB Sant Pau, Barcelona, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Wojtek Wiercioch
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Małgorzata M. Bała
3Dept of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rafał R. Jaeschke
4Section of Affective Disorders, Dept of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Krzysztof Styczeń
4Section of Affective Disorders, Dept of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hector Pardo-Hernandez
2Iberoamerican Cochrane Centre, CIBERESP-IIB Sant Pau, Barcelona, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Hector Pardo-Hernandez
Anna Selva
5Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí, Sabadell, Spain
6Research Network on Health Services in Chronic Diseases (REDISSEC), Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Housne Ara Begum
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gian Paolo Morgano
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marcin Waligóra
7REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Arnav Agarwal
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
8School of Medicine, University of Toronto, Toronto, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Matthew Ventresca
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karolina Strzebońska
7REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mateusz T. Wasylewski
7REMEDY, Research Ethics in Medicine Study Group, Dept of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lídia Blanco-Silvente
9TransLab Research Group, Dept of Medical Sciences, University of Girona, Girona, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Janna-Lina Kerth
10Dept for Medical Didactics and Curricular Development, Medical Faculty RWTH Aachen University, Aachen, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mengxiao Wang
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yuqing Zhang
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Saiprasad Narsingam
11Dept of Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yutong Fei
12Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gordon Guyatt
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
13Dept of Medicine, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Holger J. Schünemann
1Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
13Dept of Medicine, McMaster University, Hamilton, ON, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • Supplementary Materials
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Flow diagram for systematic review on chronic obstructive pulmonary disease patients’ values and preferences.

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Forest plots for EuroQol-5D (EQ-5D) utility of chronic obstructive pulmonary disease patients with forced expiratory volume in 1 s a) ≥80%, b) <80–≥50%, c) <50–≥30% and d) <30% predicted.

Tables

  • Figures
  • Supplementary Materials
  • TABLE 1

    Summary of findings

    Health state/outcome
    (categories of values and preferences)
    Estimates of outcome importance range across studies/pooled mean (95% CI)Participants/studiesCertainty of evidenceInterpretation of findings
    Exacerbation (utility# measured with visual analogue scale¶)0.259–0.580/0.462 (0.453–0.471)####1991/8####+++−
    Moderate certainty due to inconsistency####
    Most people find exacerbation of COPD probably has a large impact on their lives. There is probably no important variability for this assessment.
    Exacerbation (EQ-5D utility+)0.430–0.683/0.519 (0.502–0.537)¶¶¶¶927/3¶¶¶¶++−−
    Low certainty due to inconsistency and indirectness¶¶¶¶,######
    Most people find exacerbation of COPD probably has a large impact on their lives. There is probably no important variability for this assessment.
    Exacerbation (disutility)§Visual analogue scale
     1 nonserious exacerbation: −0.037 (0.005)
     2 nonserious exacerbations: −0.068 (0.005)
     1 serious exacerbation: −0.090 (0.007)
     1 nonserious and 1 serious exacerbation: −0.130 (0.007)
    Time trade off
     1 nonserious exacerbation: −0.010 (0.007)
     2 nonserious exacerbations: −0.021 (0.007)
     1 serious exacerbation: −0.042 (0.009)
     1 nonserious and 1 serious exacerbation: −0.088 (0.009)
    239/1++++
    High certainty
    Most people find exacerbation of COPD has an impact on their lives, which grows larger as the severity of exacerbation progresses. There is probably no important variability for this assessment.
    Level 1 dyspnoea (utility measured with visual analogue scale)ƒ0.751146/1ƒ++++
    High certaintyƒ
    Most people find level 1 dyspnoea has a small to moderate impact on lives. There is probably no important variability for this assessment.
    Level 2 dyspnoea (utility measured with visual analogue scale)ƒ0.65645/1ƒ+++−
    Moderate certainty due to imprecisionƒ
    Most people find level 2 dyspnoea probably has a moderate impact on lives. There is probably no important variability for this assessment.
    Level 3 dyspnoea (utility measured with visual analogue scale)ƒ0.5267/1ƒ++−−
    Low certainty due to very serious imprecisionƒ
    Most people find level 3 dyspnoea probably has a large impact on lives. There is probably no important variability for this assessment.
    Adverse events (discrete choice)##Two studies suggested that patients consider adverse events as important outcomes. One study suggested adverse events were more important than onset time of medicine, ease of use, rescue medicine use. Another suggested adverse events were more important than costs of treatment, extent to which the patient sees the same doctor each time and extent to which the doctor treats the patient as an entire person. Both studies concluded symptom relief to be more important than adverse events.564/2+++−
    Moderate certainty due to risk of bias##
    People probably consider adverse events as an important outcome. There is likely no important variability for this assessment.
    Extent of symptom relief (discrete choice)##Two studies compared extend of symptom relief with other outcomes. Extent of symptom relief was considered the most important outcome in these two studies.564/2+++−
    Moderate certainty due to risk of bias##
    Most people probably find symptom relief as important outcome. There is probably no important variability for this assessment.
    Extent of symptom relief (forced choice)¶¶In a survey on expectation of treatment, greater symptomatic relief was chosen by 82.3% of the participants, thus the most important outcome. Extent of symptom relief was considered the second most important outcome in one cross-sectional study (less preferred “not to be kept alive on life support when there is little hope for a meaningful recovery”). Another study reported 58.0% of the participants would prefer treatment focusing on relieving pain and discomfort rather than extending life.1640/3+++−
    Moderate certainty due to risk of bias¶¶
    Most people probably find symptom relief as important outcome. There is probably no important variability for this assessment.
    Very severe COPD (utility measured with visual analogue scale)++0.321–0.651/0.345 (0.335–0.354)++++746/7++−−
    Low certainty due to risk of bias++++++ and inconsistency++
    Most people find very severe COPD seems to have a large impact on lives. There is probably important variability for this assessment.
    Very severe COPD (EQ-5D utility)§§0.520–0.740/0.681 (0.667–0.694)§§§§898/10+++−
    Moderate certainty due to inconsistency§§§§
    Most people find very severe COPD probably has a large impact on lives. There is probably important variability for this assessment.
    Severe COPD (utility measured with visual analogue scale)ƒƒ0.446–0.689/0.508 (0.501–0.515)ƒƒƒƒ4683/8++−−
    Low certainty due to risk of bias++++++ and inconsistency ƒƒƒƒ
    Most people find severe COPD probably has a moderate to large impact on lives. There is probably important variability for this assessment.
    Severe COPD (EQ-5D utility)###0.620–0.810/0.741 (0.734–0.749)#####4352/11+++−
    Moderate certainty due to inconsistency#####
    Most people find severe COPD probably has a moderate to large impact on lives. There is probably important variability for this assessment.
    Moderate COPD (utility measured with visual analogue scale)¶¶¶0.589–0.726/0.639 (0.635–0.642)¶¶¶¶¶9664/10++−−
    Low certainty due to risk of bias++++++ and inconsistency¶¶¶¶¶
    Most people find moderate COPD probably has a moderate impact on lives. There is probably important variability for this assessment.
    Moderate COPD (EQ-5D utility)+++0.680–0.890/0.821 (0.815–0.826)+++++4620/9+++−
    Moderate certainty due to inconsistency+++++
    Most people find moderate COPD probably has a moderate impact on lives. There is probably important variability for this assessment.
    Mild COPD (utility measured with visual analogue scale)§§§0.680–0.811/0.738 (0.732-0.746)§§§§§3623/8++−−
    Low certainty due to risk of bias++++++ and inconsistency§§§§§
    Most people find moderate COPD probably has a small to moderate impact on lives. There is likely important variability for this assessment.
    Mild COPD (EQ-5D utility)ƒƒƒ0.770–0.900/0.873 (0.863–0.883)ƒƒƒƒƒ2067/7+++−
    Moderate certainty due to inconsistency ƒƒƒƒƒ
    Most people find moderate COPD probably has a small to moderate impact on lives. There is probably important variability for this assessment.

    Grading of Recommendations Assessment, Development and Evaluation Working Group grades of evidence: here we assessed the certainty of evidence on mean outcome importance. We use “certainty of evidence”, “certainty in estimates”, “quality of evidence” and “strength of evidence” interchangeably. High certainty: we are very confident that the true value of outcome importance lies close to that of the estimate. Moderate certainty: we are moderately confident in the estimate; the true value of outcome importance is likely to be close to the estimate but there is a possibility that it is substantially different. Low certainty: our confidence in the estimate is limited; the true value of outcome importance may be substantially different from the estimate. Very low certainty: we have very little confidence in the estimate; the true value of outcome importance is likely to be substantially different from the estimate EQ-5D: EuroQol-5D; COPD: chronic obstructive pulmonary disease. #: utilities represent the value individuals place on different outcomes; they are measured on an interval scale, with 0 reflecting states of health equivalent to death/worst imaginable health and 1 (or 100 in some cases) reflecting perfect health/best imaginable health. ¶: eight studies [19–26] used EQ-5D visual analogue scale to elicit health state values on exacerbation of COPD. +: three studies [21–23] used EQ-5D utility to elicit the importance of outcome. §: Rutten van Molken et al. [27] reported the disutility due to the exacerbations; the measurement tools included visual analogue scale and time trade off; the researchers estimated the disutility due to exacerbation using random effects regression analysis. ƒ: Kim et al. [28] reported the utility of dyspnoea, according to the levels of breathlessness (level 1, short of breath during strenuous activities; level 2, stopping to catch breath after a few minutes walking; level 3, breathless when dressing or washing); in a total sample of 200, the numbers of participants experiencing level 1, 2 and 3 breathlessness were 146, 45 and seven, respectively; due to small sample size, we downgraded the certainty of evidence by one level for the estimates of level 2 breathlessness and two levels for level 3 breathlessness. ##: Bulcun et al. [29] compared extent of symptom relief with extent to which the doctor gives sufficient time to listen to the patient, possibility of experiencing adverse effects from treatment, costs of treatment, extent to which the patient sees the same doctor each time and extent to which the doctor treats the patient as an entire person; Kawata et al. [30] recruited 515 patients for an online voluntary survey on the comparison of importance of symptom relief, speed of symptom relief, rescue medicine use and side-effects; participants' eligibility and their answers were considered as having serious risk of bias. ¶¶: three studies [31–33] asked directly what participants would prefer in facing a COPD treatment decision; the questions included expectation of treatment, reasons to continue or not continue with treatment and preferred treatment characteristics; the assessment was at risk of bias due to unclear reliability and validity features. ++: [27, 28, 34–37]. §§: [27, 28, 35–42]. ƒƒ: [27, 28, 34–37, 43, 44]. ###: [28, 35–40, 43, 44]. ¶¶¶: [27, 28, 34–37, 43, 44–46]. §§§: [27, 28, 34–37, 43, 45]. ƒƒƒ: [28, 35–37, 42, 43, 45]. ####: across eight included studies, the point estimates range from 0.259 to 0.580; using inverse-variance method to pool the estimates, the I2 (95.5%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study populations cannot explain the source of heterogeneity (the participants in the studies were exacerbation patients, exacerbation patients not needing hospitalisation, ambulatory patients and hospitalised patients due to exacerbation). ¶¶¶¶: across three included studies, the point estimates range from 0.430 to 0.683; using inverse-variance method to pool the estimates, the I2 (95.5%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study populations cannot explain the source of heterogeneity (the participants in the three studies were exacerbation patients, exacerbation patients not needing hospitalisation and ambulatory patients). ++++: the point estimates range from 0.321 to 0.651; using inverse-variance method to pool the estimates, the I2 (98.5%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study population cannot explain the source of heterogeneity. §§§§: the point estimates range from 0.520 to 0.740; using inverse-variance method to pool the estimates, the I2 (80.2%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study population cannot explain the source of heterogeneity. ƒƒƒƒ: the point estimates range from 0.446 to 0.689; using inverse-variance method to pool the estimates, the I2 (98.8%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study population cannot explain the source of heterogeneity. #####: the point estimates range from 0.620 to 0.810; using inverse-variance method to pool the estimates, the I2 (94.5%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study population cannot explain the source of heterogeneity. ¶¶¶¶¶: the point estimates range from 0.589 to 0.726; using inverse-variance method to pool the estimates, the I2 (97.9%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study population cannot explain the source of heterogeneity. +++++: the point estimates range from 0.680 to 0.890; using inverse-variance method to pool the estimates, the I2 (97.8%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study population cannot explain the source of heterogeneity. §§§§§: the point estimates range from 0.680 to 0.811; using inverse-variance method to pool the estimates, the I2 (88.0%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study population cannot explain the source of heterogeneity. ƒƒƒƒƒ: the point estimates range from 0.770 to 0.900; using inverse-variance method to pool the estimates, the I2 (91.3%) and statistical test (<0.001) suggest potential heterogeneity across studies; the difference in study population cannot explain the source of heterogeneity. ######: we rated down the quality of evidence for indirectness because an indirect measurement tool (EQ-5D) was used to elicit the utility of outcomes. ++++++: we downgraded the certainty in evidence because of low response rate observed by Lin et al. [35] and the potentially biased sampling strategy by asking physicians to provided recruited patients by Boros and Lubinski [34].

    • TABLE 2

      Utility of exacerbation or hospitalisation due to exacerbation

      StudyInstrumentReport formatResults
      Alcazar et al. [19]EQ-5D VASMean±sdHospitalised patients: 0.551±0.197
      Antoniu et al. [20]EQ-5D VASMean±sdHospitalised patients: 0.279±0.252
      Bourbeau et al. [47]EQ-5D VASMean±sdChange from baseline: −0.126±0.190
      Cross et al. [21]EQ-5D VASMean±sdExacerbation of COPD: manual chest physiotherapy arm 0.450±0.210; no manual chest physiotherapy arm 0.466±0.214
      EQ-5D utilityMean±sdExacerbation of COPD: manual chest physiotherapy arm 0.450±0.320; no manual chest physiotherapy arm 0.430±0.360
      Goossens et al. [22]EQ-5D VASMean±sdExacerbation (at enrolment): 0.367±0.252
      EQ-5D utilityMean±sdExacerbation (at enrolment): 0.683±0.209
      Menn et al. [39]EQ-5D utilityMean±sdEQ-5D Admission Stage III: 0.620±0.260
      EQ-5D Admission Stage IV: 0.600±0.260
      SF-6D utilityMean±sdSF-12-SF-6D Admission Stage III: 0.610±0.130
      SF-12-SF-6D Admission Stage IV: 0.540±0.080
      Miravitlles et al. [23]EQ-5D utilityMean±sdEQ-5D index baseline (exacerbation): 0.540±0.230
      EQ-5D VASMean±sdEQ VAS baseline (exacerbation): 0.344±0.274
      O'Reilly et al. [24]EQ-5D utilityMean±sdHospital admission: −0.077±0.397
      EQ-5D VASHospital admission: 0.259±0.170
      Punekar et al. [43]EQ-5D utilityMean (95% CI)1–2 exacerbations in primary care physician setting: 0.740 (0.720–0.770)
      >3 exacerbations in primary care physician setting: 0.610 (0.590–0.640)
      1–2 exacerbations in respiratory specialist setting: 0.730 (0.710–0.760)
      >3 exacerbations in respiratory specialist setting: 0.570 (0.540–0.600)
      Rutten van Molken et al. [27]VASRegression coefficient±sem1 nonserious exacerbation: −0.037±0.005
      2 nonserious exacerbations: −0.068±0.005
      1 serious exacerbation: −0.090±0.007
      1 nonserious and 1 serious exacerbation: −0.130±0.007
      TTO1 nonserious exacerbation: −0.010±0.007
      2 nonserious exacerbations: −0.021±0.007
      1 serious exacerbation: −0.042±0.009
      1 nonserious and 1 serious exacerbation: −0.088±0.009
      Seymour et al. [25]EQ-5D VASMean±sdCOPD baseline in usual care group: 0.540±0.170
      COPD baseline in post-exacerbation pulmonary rehabilitation group: 0.580±0.180
      Solem et al. [40]EQ-5D utilityMean±sdPatients recently experiencing a severe exacerbation: 0.627±0.210
      Patients recently experiencing a moderate exacerbation. 0.698±0.197
      Patients who had experienced ≥3 exacerbations in the previous year: 0.638±0.212
      Patients who had experienced 2 exacerbations in the previous year: 0.684±0.204
      Patients who had experienced 1 exacerbation in the previous year: 0.727±0.175
      Current health (last exacerbation): 0.552±0.283
      Thought back, patients experiencing a severe exacerbation (last exacerbation): 0.471±0.313
      Thought back, patients experiencing a moderate exacerbation (last exacerbation): 0.595±0.257
      Very severe COPD (last exacerbation): 0.494±0.312
      Severe COPD (last exacerbation): 0.590±0.256
      Patients who had experienced ≥3 exacerbations in the previous year (last exacerbation): 0.520±0.282
      Patients who had experienced 2 exacerbations in the previous year (last exacerbation): 0.552±0.306
      Patients who had experienced one exacerbation in the previous year (last exacerbation): 0.610±0.254
      Torrance et al. [48]HUIMean±sdFor the first acute exacerbation of chronic bronchitis: ciprofloxacin group: 0.720±0.200); usual care group 0.680±0.190
      For the remaining acute exacerbation of chronic bronchitis: ciprofloxacin group: 0.740±0.180; usual care group 0.690±0.220
      Wildman et al. [26]EQ-5D VASMean±sd0.549±0.195
      Median (IQR)0.500 (0.400–0.700)

      EQ-5D: EuroQol-5D; VAS: visual analogue scale; TTO: time trade-off; HUI: Health Utility Index; IQR: interquartile range; COPD: chronic obstructive pulmonary disease.

      • TABLE 3

        Importance on breathlessness, shortness of breath, or dyspnoea

        StudyInstrumentReport formatResults
        Gruenberger et al. [49]SF-6D utilityMeanSF-6D health utilities were 0.060 points lower in higher dyspnoea patients (modified Medical Research Council score ≥2) than in lower dyspnoea patients
        Kim et al. [28]EQ-5D VASMean±semEQ-5D utility
        Level 1 breathlessness (short of breath during strenuous activities): 0.870±0.020
        Level 2 breathlessness (stopping to catch breath after a few minutes walking): 0.740±0.030
        Level 3 breathlessness (breathless when dressing or washing): 0.540±0.060
        EQ-5D utilityMean±semEQ-VAS
        Level 1 breathlessness (short of breath during strenuous activities): 0.751±0.026
        Level 2 breathlessness (stopping to catch breath after a few minutes walking): 0.656±0.035
        Level 3 breathlessness (breathless when dressing or washing): 0.526±0.071
        Punekar et al. [43]EQ-5D utilityMean (95% CI)All in primary care physician setting: 0.700 (0.680–0.710)
        Breathlessness after exercising heavily in primary care physician setting: 0.880 (0.860–0.900)
        Breathlessness when hurrying on level ground in primary care physician: 0.790 (0.770–0.810)
        Too breathless to leave house in primary care physician: 0.170 (0.110–0.240)
        All in respiratory specialist setting: 0.680 (0.660–0.690)
        Breathlessness after exercising heavily in respiratory specialist setting: 0.880 (0.850–0.900)
        Breathlessness when hurrying on level ground in respiratory specialist setting: 0.790 (0.770–0.810)
        Too breathless to leave house in respiratory specialist setting: 0.290 (0.220–0.350)
        Braido et al. [50]Uncategorised surveyChoice or proportion of choiceBreathlessness as most troublesome symptom: 64.6% (ranking first; chronic cough: 13.9%; sputum production: 11.0%; exacerbation: 8.3%)
        Downey et al. [51]Uncategorised survey: End of life Priority Score (the highest priority aspect of the end-of-life period)Mean±sdIn a survey on end-of-life priority score measured by rank order (out of 5), breathing comfort was considered as priority: 1.27±1.83 (ranking third, only after time with family and friends, and pain under control)
        Haughney et al. [52]Conjoint analysis/discrete choice analysisMeanBreathlessness was considered important for patients. Of all the attributes, it was after “impact on everyday life”, “need for medical care” and “number of future attacks”. It is more important than speed of recovery, productive cough, social impact, sleep disturbance and impact on mood.
        Hernández et al. [53]Impact of shortness of breathChoice or proportion of choiceShortness of breath is an important outcome, because 6.0% of participants stated the impact on activities of daily living was extreme, 29.0% “very much”, 24.0% “a little” and 13.0% “not at all”
        Miravitlles et al. [54]Ideal characteristics of a COPD therapyChoice or proportion of choice37.0% of the participants chose “increased shortness of breath” as the symptom that has a high impact on wellbeing (ranking second; increased coughing 42.0%, increased fatigue 37.0%, increased production of sputum 35.0%, increased frequency of chest pains 20.0% and fever 13.0%)
        Pisa et al. [55]Direct choice: relative importance of COPD attributes (%, higher proportion indicating more importance)Choice or proportion of choiceDyspnoea was considered the most important COPD attribute
        Relative importance of COPD attributes
        Dyspnoea: 36.0%
        Performance capability (bodily resilience) due to COPD: 19.0%
        Sleep quality due to COPD: 19.0%
        Onset of action of the medication: 3.0%
        Frequency of administration of the medication: 6.0%
        Health state after awakening (day start) due to COPD: 13.0%
        Emotional state due to COPD base medication: 4.0%
        Effect of attribute levels on health state preference: part-worth utilities (higher value indicating more importance):
         Dyspnoea
          Never dyspnoea, except on strong exertion: 115.80
          Dyspnoea on exertion: 38.20
          Dyspnoea at normal walking pace: −6.60
          Dyspnoea on slight effort: −10.10
          Dyspnoea even at rest: −137.40
        Polati et al. [56]Uncategorised survey: expectation of treatmentChoice or proportion of choice120 (24.1%) patients would like to have more ease with “breathing” due to treatment; if they were doctors, 215 (43.3%) patients would like to first heal shortness of breath. For both questions, breathing problems were considered most important compared with other symptoms.
        Reinke et al. [57]Forced choice: treatmentChoice or proportion of choicePreferences about death and dying questionnaire. 52.6% of 357 patients chose “being able to breath comfortably in the last 7 days of life” as preferred characteristics of treatment.
        Rocker et al. [31]Uncategorised survey: reasons to continue (or not) with opioidsChoice or proportion of choiceI would strongly prefer when followed up at 2 months, 8 (23.5%) and 1 (2.9%) patient claimed would “strongly prefer” and “prefer” to continue on opioids because they provide significant relief from dyspnoea; while at 4–6 months, 12 (29.3%) and 7 (17.1%) patients claimed would “strongly prefer” and “prefer” to continue on opioids because they provide significant relief from dyspnoea.
        Wilson et al. [58]Importance of mechanical ventilation: scales for the specific questions about mechanical ventilationMedian (IQR)On a scale of 1–4 (0: not at all important; 1: a little; 2: quite a bit; 3: very much; 4: extremely important), the score for easing breathlessness was 2.5 (1.8–3.0) for those forego mechanical ventilation, and 3.0 (2.8–4.0) for those uncertain/accept mechanical ventilation.

        EQ-5D: EuroQol-5D; VAS: visual analogue scale; COPD: chronic obstructive pulmonary disease; IQR: interquartile range.

        • TABLE 4

          Importance of adverse events

          StudyInstrumentReported formatResults
          Bulcun et al. [29]Conjoint analysis/discrete choice analysisInfluence or contribution or weight of certain aspects/attributesPossibility of experiencing adverse effects from treatment
           20%: −0.90
           10%: −0.06
           4%: 1.00
          Difference between highest and lowest utility levels: 8.20
          The sequence of attributes from most important to least
           important: extent to which the doctor gives sufficient
           time to listen to the patient, possibility of experiencing
           adverse effects from treatment, costs of treatment,
           extent to which the patient sees the same doctor each
           time, and extent to which the doctor treats the patient
           as an entire person.
          Kawata et al. [30]Willingness to pay, conjoint analysis/discrete choice analysisMean (95% CI)Utility score
           Mild side-effects (no side-effects as reference): −0.29
            (−0.33– −0.24)
           Moderate to severe side-effects (no side-effects as
            reference): −1.13 (−1.18– −1.09)
           Willingness to pay
           Mild side-effects (no side-effects as reference): $14.81
            ($12.40–17.22)
           Moderate to severe side-effects (no side-effects as
            reference): $58.69 ($56.28–61.11)
          Adverse event was considered important for COPD treatment. It was the second most important, only after “complete symptom relief”, and more important than “rarely use rescue medication”, “quick and easy to use inhaler” and “feeling medication work quickly”.
          Miravitlles et al. [54]Ideal characteristics of a COPD therapyChoice or proportion of choiceIdeal characteristics of a COPD therapy as listed by survey respondents
           Fewer side-effects 36.0%
          The sequence of ideal characteristics from most important to least important: quick symptom relief, longer intervals between flare-ups, fewer side-effects, better ability to cope with daily chores again, lower costs of treatment, better doses.
          Patridge et al. [59]Uncategorised survey: perception of disease severityChoice or proportion of choice30.6% of participants expressed concern regarding potential medication side-effects, and on average, patients considered that explaining clearly what are the possible side-effects and risks of the products was very important (9.0 out of 10 on a scale with 1 indicating not at all important and 10 indicating extremely important).
          Sharafkhaneh et al. [60]Primary disadvantages of nebulisation therapyChoice or proportion of choiceQuestion: what do you see as the main negatives or disadvantages of nebulisation?
           No negatives: 86 (21.5%)
           Side-effects: 46 (11.5%)
          The sequence of disadvantages from most important to least important: device immobile/bulky/cumbersome, time-consuming, side-effects, inconvenient, don't like doing it, having to use it several times a day, care and clean-up after use, too expensive.

          COPD: chronic obstructive pulmonary disease.

          • TABLE 5

            Utility of different chronic obstructive pulmonary disease (COPD) severities

            StudyInstrumentReported formatGOLD classifications
            Mild COPD#Moderate COPD¶Severe COPD+Very severe COPD§
            Boros and Lubinski [34]VASMean (95% CI, sd)0.730 (0.722–0.739, 0.164)0.626 (0.621–0.630, 0.164)0.446 (0.439–0.452, 0.161)0.321 (0.302–0.339, 0.171)
            Chen et al. [38]EQ-5D utilityMean0.6860.565
            SF-6D utilityƒMean0.6460.597
            Hong et al. [45]EQ-5D utilityMean±sd0.900±0.1400.890±0.1400.840±0.150
            EQ-5D VASMean±sd0.730±0.1860.708±0.1910.609±0.234
            Kim et al. [28]EQ-5D utilityMean±sd (adjusted mean±sem)0.830±0.170
            (0.830±0.040)
            0.880±0.120
            (0.880±0.020)
            0.820±0.160
            (0.810±0.030)
            0.610±0.260
            (0.600±0.040)
            EQ-5D VASMean±sd (adjusted mean±sem)0.719±0.189
            (0.739±0.054)
            0.719±0.178
            (0.751±0.029)
            0.650±0.206
            (0.689±0.033)
            0.609±0.139
            (0.651±0.056)
            Lin et al. [35]EQ-5D utilityMean±sd0.810±0.1400.810±0.1400.760±0.1700.740±0.150
            EQ-5D VASMean±sd0.766±0.1750.726±0.1910.657±2010.611±0.197
            Menn et al. [39]EQ-5D utilityMean±sd0.620±0.2600.600±0.260
            SF-6D utilityMean±sd0.610±0.1300.540±0.080
            Pickard et al. [36]EQ-5D utility##Mean±sd0.800±0.1300.700±0.2100.720±0.1900.720±0.160
            EQ-5D utility¶¶Mean±sd0.730±0.1900.590±0.3200.630±0.2500.630±0.240
            EQ-5D VASMean±sd0.743±0.1630.662±0.2000.601±0.1840.587±0.158
            Punekar et al. [43]EQ-5D utilityMean (95% CI)0.770 (0.730–0.810) in primary care setting0.680 (0.620–0.740)0.620 (0.560–0.680)
            EQ-5D utilityMean (95% CI)0.680 (0.640–0.720) in respiratory specialist care setting0.720 (0.690–0.750)0.640 (0.610–0.720)
            Rodriguez Gonzalez-Moro et al.[46]EQ-5D VASMean (95% CI)0.589 (0.581–0.599)0.459 (0.449–0.467)
            Rutten van Molken et al. [44]EQ-5D VASMean (95% CI)0.677 (0.665–0.690)0.625 (0.610–0.639)0.578 (0.545–0.612)
            EQ-5D utility¶¶Mean (95% CI)0.787 (0.771–0.802)0.750 (0.731–0.768)0.647 (0.598–0.695)
            EQ-5D utility##Mean (95% CI)0.832 (0.821–0.843)0.803 (0.790–0.816)0.731 (0.699–0.762)
            Rutten van Molken et al. [27]VASMean±semMild COPD: 0.811±0.011Disutility of moderate COPD in relation to mild COPD: −0.133±0.006Disutility of severe COPD in relation to mild COPD: −0.354±0.006Disutility of very severe COPD in relation to mild COPD: −0.508±0.006
            TTOMean±semMild COPD: 0.974±0.017Disutility of moderate COPD in relation to mild COPD: −0.045±0.008Disutility of severe COPD in relation to mild COPD: −0.257±0.008Disutility of very severe COPD in relation to mild COPD: −0.452±0.008
            Scharf et al. [62]HUI utilityMean±sd0.400±0.3300.580±0.3600.530±0.3500.390±0.510
            Solem et al. [40]EQ-5D utilityMean±sd0.707±0.1740.623±0.234
            Stahl et al. [37]EQ-5D VASMean±sd0.730±0.2100.650±0.2400.620±0.2100.370±0.280
            EQ-5D utilityMean±sd0.840±0.1500.730±0.2300.740±0.2500.520±0.260
            Starkie et al. [41]EQ-5D utilityMean±sdObserved utility for moderate COPD: 0.752±0.220Observed utility for severe COPD: 0.708±0.230Observed utility for very severe COPD: 0.672±0.220
            Szende et al. [42]EQ-5D utilityMean±sd0.850±0.1600.730±0.2100.740±0.2400.530±0.280
            SF-6D utilityMean±sd0.800±0.1300.730±0.1300.730±0.1400.620±0.150

            GOLD: Global Initiative for Chronic Obstructive Lung Disease; VAS: visual analogue scale; EQ-5D: EuroQol-5D; TTO: time trade-off; HUI: Health Utility Index. #: forced expiratory volume in 1 s (FEV1) ≥80% predicted; ¶: FEV1 <80–≥50% predicted; +: FEV1 <50–≥30% predicted; §: FEV1 <30% predicted; ƒ: Hong Kong value set; ##: US value set; ¶¶: UK value set.

            Supplementary Materials

            • Figures
            • Tables
            • Supplementary Material

              Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

              Search strategy ERJ-00222-2018_Search_Strategy

              References of all included studies ERJ-00222-2018_References_of_Included_Studies

              TABLE S1 Study characteristics ERJ-00222-2018_tableS1

              TABLE S2 Summary of risk of bias ERJ-00222-2018_tableS2

              TABLE S3 Quantitative results ERJ-00222-2018_tableS3

            PreviousNext
            Back to top
            View this article with LENS
            Vol 52 Issue 1 Table of Contents
            European Respiratory Journal: 52 (1)
            • Table of Contents
            • Index by author
            Email

            Thank you for your interest in spreading the word on European Respiratory Society .

            NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

            Enter multiple addresses on separate lines or separate them with commas.
            A systematic review of how patients value COPD outcomes
            (Your Name) has sent you a message from European Respiratory Society
            (Your Name) thought you would like to see the European Respiratory Society web site.
            CAPTCHA
            This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
            Print
            Citation Tools
            A systematic review of how patients value COPD outcomes
            Yuan Zhang, Rebecca L. Morgan, Pablo Alonso-Coello, Wojtek Wiercioch, Małgorzata M. Bała, Rafał R. Jaeschke, Krzysztof Styczeń, Hector Pardo-Hernandez, Anna Selva, Housne Ara Begum, Gian Paolo Morgano, Marcin Waligóra, Arnav Agarwal, Matthew Ventresca, Karolina Strzebońska, Mateusz T. Wasylewski, Lídia Blanco-Silvente, Janna-Lina Kerth, Mengxiao Wang, Yuqing Zhang, Saiprasad Narsingam, Yutong Fei, Gordon Guyatt, Holger J. Schünemann
            European Respiratory Journal Jul 2018, 52 (1) 1800222; DOI: 10.1183/13993003.00222-2018

            Citation Manager Formats

            • BibTeX
            • Bookends
            • EasyBib
            • EndNote (tagged)
            • EndNote 8 (xml)
            • Medlars
            • Mendeley
            • Papers
            • RefWorks Tagged
            • Ref Manager
            • RIS
            • Zotero

            Share
            A systematic review of how patients value COPD outcomes
            Yuan Zhang, Rebecca L. Morgan, Pablo Alonso-Coello, Wojtek Wiercioch, Małgorzata M. Bała, Rafał R. Jaeschke, Krzysztof Styczeń, Hector Pardo-Hernandez, Anna Selva, Housne Ara Begum, Gian Paolo Morgano, Marcin Waligóra, Arnav Agarwal, Matthew Ventresca, Karolina Strzebońska, Mateusz T. Wasylewski, Lídia Blanco-Silvente, Janna-Lina Kerth, Mengxiao Wang, Yuqing Zhang, Saiprasad Narsingam, Yutong Fei, Gordon Guyatt, Holger J. Schünemann
            European Respiratory Journal Jul 2018, 52 (1) 1800222; DOI: 10.1183/13993003.00222-2018
            del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
            Full Text (PDF)

            Jump To

            • Article
              • Abstract
              • Abstract
              • Introduction
              • Methods
              • Results
              • Discussion
              • Supplementary material
              • Acknowledgements
              • Footnotes
              • References
            • Figures & Data
            • Info & Metrics
            • PDF

            Subjects

            • COPD and smoking
            • Tweet Widget
            • Facebook Like
            • Google Plus One

            More in this TOC Section

            Original articles

            • Ambulatory management of secondary spontaneous pneumothorax
            • Systematic assessment of respiratory health in illness susceptible athletes
            • Identifying early PAH biomarkers in systemic sclerosis
            Show more Original articles

            COPD

            • Use of singing for lung health in COPD
            • Response to exercise training and withdrawal in COPD
            • A phase 2a crossover trial in COPD of the bronchodilator navafenterol
            Show more COPD

            Related Articles

            Navigate

            • Home
            • Current issue
            • Archive

            About the ERJ

            • Journal information
            • Editorial board
            • Reviewers
            • Press
            • Permissions and reprints
            • Advertising

            The European Respiratory Society

            • Society home
            • myERS
            • Privacy policy
            • Accessibility

            ERS publications

            • European Respiratory Journal
            • ERJ Open Research
            • European Respiratory Review
            • Breathe
            • ERS books online
            • ERS Bookshop

            Help

            • Feedback

            For authors

            • Instructions for authors
            • Publication ethics and malpractice
            • Submit a manuscript

            For readers

            • Alerts
            • Subjects
            • Podcasts
            • RSS

            Subscriptions

            • Accessing the ERS publications

            Contact us

            European Respiratory Society
            442 Glossop Road
            Sheffield S10 2PX
            United Kingdom
            Tel: +44 114 2672860
            Email: journals@ersnet.org

            ISSN

            Print ISSN:  0903-1936
            Online ISSN: 1399-3003

            Copyright © 2022 by the European Respiratory Society