Development of a Communication Tool between Patients and Physicians for Recognizing COPD Exacerbations in Japan

Figures & data

Table 1. Patient demographics and clinical characteristics.

	Part 1 (N = 41)	Part 2 (N = 9)	Part 3 (N = 100)
Age, years, mean (range)	74.1 (57–94)	75.4 (56–90)	72.3 (45–88)
Male, n (%)	35 (85.4)	7 (77.8)	85 (85.0)
Education background, n (%)
Elementary/Jr. High School	19 (46.3)	0 (0.0)	30 (30.0)
High School	12 (29.3)	6 (66.7)	54 (54.0)
Jr. College/Technical Jr. College	1 (2.4)	1 (11.1)	5 (5.0)
University/Grad School	9 (22.0)	2 (22.2)	11 (11.0)
Geographical area^a, n (%)
Urban	23 (56.1)	6 (66.7)	44 (44.0)
Rural	18 (43.9)	3 (33.3)	56 (56.0)
Smoking status, n (%)
Current	12 (29.3)	3 (33.3)	66 (66.0)
Former	29 (70.7)	6 (66.7)	34 (34.0)
Smoking, pack-years (range)	56.0 (10–148)	49.4 (18–90)	63.9 (10–165)
Disease duration, n (%)
1‒<5 years^b	15 (36.6)	3 (33.3)	42 (42.0)
5‒<10 years	20 (48.8)	4 (44.4)	27 (27.0)
10‒<15 years	6 (14.6)	1 (11.1)	22 (22.0)
≥15 years	NR	1 (11.1)	9 (9.0)
FEV1 % predicted (range)	45.4 (1–79)	58.3 (26–83)	54.8 (16–116)
CAT score (range)	17.0 (1–39)	13.7 (6–23)	15.6 (0–36)
COPD exacerbations in last 12 months, mean (range)	1.6 (1–5)	1.9 (1–6)	1.8 (1–10)
Requiring hospitalization, mean (range)	0.8 (0–2)	0.4 (0–2)	0.6 (0–5)

^a Urban was defined as ordinance-designated cities/core cities, rural was defined as other than urban.

^b Includes patients whose disease duration was less than 1 year.

CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 s; NR, not reported.

Figure 1. Focus groups: frequency of the most common words or phrases considered to be important to patients in describing exacerbations to others^a (n = 41). ^aDuplicate responses were included.

Figure 2. Part 3 questionnaire responses: demonstrating distribution of (A) Items 1–20 and (B) Items 21–26. Items 22 to 26 were questions about phlegm that were only completed by patients who selected “rarely”, “occasionally”, or “frequently” to item 21.

Figure 3. Scree plot from factor analysis.

Table 2. Factor loadings after rotation.

Item number and description of each item^a	Factor 1	Factor 2	Factor 3	Factor 4	Response rate (%)
19. Breathlessness: long-distance walks	1.05	−0.06	0.00	−0.03	80.0
18. Difficulty breathing: long-distance walks	0.87	0.13	−0.07	−0.02	78.8
20. Tightness in the chest: long distance walks	0.81	0.03	0.13	−0.02	69.0
17. Difficulty breathing: up hills	0.67	0.11	0.04	0.13	78.0
12. Social activity limited due to difficulty breathing^c	0.07	0.96	−0.05	−0.03	48.0
11. Daily activity limited due to difficulty breathing^c	0.17	0.76	−0.12	0.03	48.0
8. Going out avoided due to difficulty breathing	0.02	0.76	0.09	0.01	37.0
15. Difficulty breathing: walking outside^d	0.46	0.48	−0.07	0.01	80.0
6. Wheezing	0.01	0.41	0.38	−0.02	50.0
21. Frequency of phlegm	−0.05	0.06	0.84	0.00	55.1
23. Volume of phlegm	0.03	0.03	0.75	−0.02	53.8
26. Stickiness of phlegm	0.13	0.08	0.61	0.01	47.3
1. Amount of cough	−0.14	−0.07	0.61	0.03	56.6
22. Difficulty bringing up phlegm	0.10	0.11	0.51	0.03	47.3
24. Change in phlegm color	0.08	−0.18	0.48	−0.03	49.5
16. Difficulty breathing: up stairs^d	0.33	0.13	0.00	0.62	80.0

Note: Values in bold indicate factor loading >0.4. The Ultra-Heywood option was used for four-factor analysis.

^a 96 samples without any missing items were included; ^bResponse rates were calculated based on the population who provided responses with the first grouping; ^cResponse rates were calculated from patients selected “moderately, quite a bit, extremely” in Q11 and/or Q12; ^dResponse rates were calculated from patients selected "moderately, quite a bit, extremely" in Q15 and/or Q16.

Figure 4. Final CERT-J.

CERT-J, COPD Exacerbation Recognition Tool in Japan; COPD, chronic obstructive pulmonary disease.

Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.