Detection and severity grading of COPD exacerbations using the exacerbations of chronic pulmonary disease tool (EXACT)

Abstract

Uncertainty exists over the ability of the exacerbations of chronic pulmonary disease tool (EXACT) patient-reported outcome diary to quantify exacerbation severity and frequency. To clarify this, we investigated the ability of the EXACT to assess severity of exacerbations and examined the relationship between exacerbations diagnosed using London chronic obstructive pulmonary disease (COPD) cohort diary cards, physician review and symptom-defined events using the EXACT.58 patients enrolled in the London Chronic Obstructive Pulmonary Disease (COPD) cohort prospectively completed the EXACT during 128 cohort diary card-defined exacerbations between January 2010 and April 2012.Mean¡SD EXACT scores increased from 42.6¡8.6 at baseline to 48.0¡8.6 at exacerbation onset (p,0.001), and rose further to a maximum score of 54.1¡8.9. Maximum EXACT scores were significantly higher in treated than untreated events. Time taken for EXACT scores to return to baseline was significantly related to symptom recovery time as judged by London COPD cohort diary cards, and to peak expiratory flow rate recovery. ,50% of both diary card-defined and healthcare utilisation exacerbations crossed the EXACT event threshold. However, only 27.9% of diary card-defined and 34.6% of healthcare utilisation exacerbations fully met the criteria for an EXACT event. Patients exhibited smaller rises in the EXACT score at exacerbation as baseline disease severity increased.The EXACT is an effective method of evaluating chronic obstructive pulmonary disease exacerbation severity. However, concerns remain about the ability of the EXACT to accurately detect exacerbations. @ERSpublications The EXACT is an effective method to assess exacerbation severity but uncertainty remains over its ability to detect exacerbations

Updates in Chronic Obstructive Pulmonary Disease for the Year 2014

“…For this reason, some instruments such as the Exacerbations of Chronic Pulmonary Disease Tool or COPD Assessment Test (CAT) may be useful in reporting and assessing the severity of exacerbations [27,28]. To date, no sputum or plasma biomarker with good sensitivity and specificity has been found that can identify either the presence or severity of an exacerbation.…”

Measuring and quantifying acute exacerbations of COPD: pitfalls and practicalities

“…A lot of time and money was spent on development of EXACT. Before we throw out the baby with the bathwater based on the results of the study by MACKAY et al [10], it is worth noting potential limitations of this study which may have affected results.…”

“…One such new measurement tool is the Exacerbations of Chronic Pulmonary Disease Tool (EXACT), a 14-item, patient-reported daily symptom diary that attempts to accurately capture the frequency, severity, and duration of exacerbations, and which is meant to be used in clinical trials and cohort studies of COPD patients [8]. A tool such as EXACT is desperately needed by COPD clinical researchers [9], assuming that it works.In this issue of the European Respiratory Journal, MACKAY et al [10] have attempted to test EXACT to see if it fulfils its expected functions. The investigators prospectively administered EXACT as well as their previously validated London COPD Cohort diary cards to 58 patients in their COPD cohort on a daily basis [10].…”

“…In this issue of the European Respiratory Journal, MACKAY et al [10] have attempted to test EXACT to see if it fulfils its expected functions. The investigators prospectively administered EXACT as well as their previously validated London COPD Cohort diary cards to 58 patients in their COPD cohort on a daily basis [10].…”

“…The investigators prospectively administered EXACT as well as their previously validated London COPD Cohort diary cards to 58 patients in their COPD cohort on a daily basis [10]. Clearly, the hope going into the study was that EXACT events and London diary card events would be concordant, and that EXACT would provide additional important information on the severity and duration of the exacerbation event that is currently not available from the London diary card.…”