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Aims: Guidelines advocate that improvement in functional status should be a major goal in COPD treatment. Many tools are available to assess aspects of functional status. This review aims to categorise systematically the available tools based on their construct (i.e. what the tool intends to measure) and to rate the tools for use in the primary care setting. Methods: PubMed was searched with the keywords 'functional status' or 'physical capacity' or 'functional capacity' and 'COPD'. All tools were categorised and rated on their measurement properties, feasibility, and usage in primary care COPD patients. The tools were divided into four constructs - functional capacity, functional performance, functional reserve, and capacity utilisation - and used the following modes of measurement: laboratory tests; semi-laboratory tests; field tests; and patient-reported outcomes. Results: The PubMed search resulted in 364 articles. Thirty-two tools were identified and rated. Conclusions: In primary care, the 6-minute walking distance test is the most reliable semi-laboratory functional capacity test, but is not very practical. The pedometer is the best functional performance field test. The Medical Research Council (MRC) dyspnoea questionnaire and the functional status domain of the Clinical COPD Questionnaire (CCQ) are the best patient-reported outcome tools to assess functional performance. [ABSTRACT FROM AUTHOR]

Background: Given the increasing importance of patient-reported outcomes (PRO) in quality medical care, we examined the value and feasibility of an innovative method for assessing patients' illness perceptions, represented in drawings made by patients with COPD of their lungs., Aim: The aim of our study was: to study patients' representation of COPD as reflected in their drawings of their lungs; and to examine scores on a validated measure that assesses illness perceptions (ie, Brief Illness Perception Questionnaire [B-IPQ])., Patients and Methods: One hundred outpatients with COPD, mean age 70 years, selected from a pharmacy database, participated and 98 filled out the B-IPQ. Eighty-seven patients completed the drawing task., Results: The illness perceptions as reflected in the responses to the B-IPQ scales represented a quite optimistic view of COPD and its consequences. The drawings of the lungs reflected a considerable discordance between patients' representations and medically accepted representations of lungs of a person with COPD., Conclusion: Assessing illness perceptions in clinical care and research about COPD offers opportunities to identify goals for patient education and self-management. Inviting patients to draw their illness is an innovative and promising approach to assessing PRO., Competing Interests: Disclosure GMA and MV are employees of Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany. AAK, JT and EB report no conflicts of interest in this work.

Background: A history of past exacerbations is a predictor of future events for patients with chronic obstructive pulmonary disease (COPD). Very little is known about the effect of pharmacologic therapies on patients with frequent or infrequent exacerbations. Methods: We conducted a post-hoc analysis of the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT ® )trial database. Patients were classified as having a low risk of exacerbations if they experienced ≤1 exacerbation and no COPD-related hospitalization(s) in the year preceding trial entry or as high risk of exacerbations if they had ≥2 exacerbations (courses of oral steroids/antibiotics) or ≥1 COPD-related hospitalization(s) in the year preceding the trial. Results: In patients at low risk or high risk for exacerbations, compared to placebo, tiotropium significantly reduced: 1) the time to first COPD exacerbation (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.74, 0.88; p <0.0001; HR: 0.89; 95% CI: 0.81, 0.97; p =0.0066, respectively); 2) the number of COPD exacerbations (rate ratio [RR]: 0.79; 95% CI: 0.72, 0.86; p <0.0001; RR: 0.88; 95% CI: 0.81; 0.95; p =0.0009). Furthermore, upon treatment with tiotropium, the proportion of patients transitioning from the low- to the high-risk exacerbations group was statistically lower compared to placebo (RR: 0.78; 95% CI: 0.67, 0.92; p =0.0030) Conclusions : This analysis shows that tiotropium reduces the risk of subsequent exacerbation and also prolongs time to first exacerbation, in both the high- and low-risk exacerbator subgroups. It also decreases the proportion of patients who shift from the low- to the high-risk exacerbations group compared to placebo., Competing Interests: Bartolome R Celli, MD, has received research grants to his academic division from AstraZeneca, advisory board or consultancy payments from GlaxoSmithKline, Boehringer Ingelheim, Almirall, AstraZeneca, Takeda, and Novartis. Neither he nor any family members have shares or commercial interests in any company. He has not received payments or had any relationship with the tobacco industry. Donald P Tashkin, MD, has received research grants to his university from Boehringer Ingelheim, AstraZeneca, Novartis, Sunovion, and GlaxoSmithKline, consultancy payments from AstraZeneca, Novartis, Sunovion, and Theravance, and speaker fees from Boehringer Ingelheim, AstraZeneca, Sunovion, and Forest. Neither he nor a member of his family has shares in any company or any relationship with the tobacco industry.Marc Decramer, MD, has received speaker fees from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Pfizer, and Novartis, consulting fees from AstraZeneca, Boehringer Ingelheim, Pfizer, Dompe, GlaxoSmithKline, Novartis, Nycomed, and Vectura, and grant support of AstraZeneca, Boehringer Ingelheim, Pfizer, GlaxoSmithKline, and Chiesi. Guus M. Asijee, PhD, is an employee of Boehringer Ingelheim. Katrin Kupas, PhD, is an independent statistician, hired by Boehringer Ingelheim.