Impact of frequency of COPD exacerbations on pulmonary function, health status and clinical outcomes

Anzueto, Antonio; Leimer, Inge; Kesten, Steven

doi:10.2147/copd.s4862

Cited by 69 publications

(24 citation statements)

References 32 publications

(40 reference statements)

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“… 1 Affected patients suffer from frequent and recurrent exacerbations, which are defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as events in the course of COPD, characterized by acute changes in patients’ baseline dyspnea, cough, and/or sputum exceeding ordinary day-to-day variations and which may warrant changes to medication. 2 Accordingly, COPD exacerbations are associated with rapid decline in lung function and physical activity, increased risk of hospitalization and mortality, 3 , 4 deterioration in health-related quality of life (HRQoL), and substantial financial burden. 3 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Exacerbation-related impairment of quality of life and work productivity in severe and very severe chronic obstructive pulmonary disease

Solem¹,

Sun²,

Sudharshan³

et al. 2013

COPD

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PurposeExacerbation-associated health-related quality of life (HRQoL) in patients with severe and very severe chronic obstructive pulmonary disease (COPD) is ill-defined. This study describes patterns, HRQoL, and the work productivity impact of COPD-related moderate and SEV exacerbations in patients with SEV/VSEV COPD, focusing on the chronic bronchitis subtype.Patients and methodsA US sample of SEV and VSEV COPD patients with recent moderate or SEV exacerbation was recruited. Along with the demographic and clinical data collected from medical records, patients reported on exacerbation frequency, health-related quality of life (HRQoL) (using the St George’s Respiratory Questionnaire for COPD [SGRQ-C] and the European Quality of Life-5 Dimensions [EQ-5D]™ index), and work productivity and activity impairment (using the Work Productivity and Activity Impairment Questionnaire – Specific Health Problem [WPAI-SHP]). The HRQoL-related impacts of exacerbation frequency, time since exacerbation, and last exacerbation severity were evaluated via linear regressions.ResultsA total of 314 patients (190 SEV/124 VSEV, mean age =68.0 years, 51% male, 28% current smokers) were included. In the previous 12 months, patients reported an average of 1.8 moderate exacerbations and 0.9 SEV exacerbations. Overall, 16% of patients were employed and reported a high percentage of overall work impairment (42.4% ± 31.1%). Activity impairment was positively associated with recent exacerbation severity (SEV 64.6% ± 26.8% versus moderate 55.6% ± 28.2%) (P=0.006). The HRQoL was significantly worse for SEV versus VSEV COPD (EQ-5D: 0.62 ± 0.23 versus 0.70 ± 0.17, respectively, and SGRQ-C: 70.1 ± 21.3 versus 61.1 ± 19.0, respectively) (P<0.001). Worse current HRQoL was reported by patients with a SEV versus moderate recent exacerbation (EQ-5D: 0.63 ± 0.21 versus 0.70 ± 0.20, respectively) (P=0.003); SGRQ-C: 70.3 ± 19.9 versus 61.7 ± 20.1, respectively (P<0.001). One additional exacerbation in the previous 12 months was associated with a 2.4-point SGRQ-C increase and a 0.02-point EQ-5D index decrease.ConclusionThe severity and frequency of COPD-related moderate/SEV exacerbations in SEV and VSEV COPD patients were positively associated with poor HRQoL and work productivity and activity impairment.

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Section: Introductionmentioning

confidence: 99%

“… 2 Accordingly, COPD exacerbations are associated with rapid decline in lung function and physical activity, increased risk of hospitalization and mortality, 3 , 4 deterioration in health-related quality of life (HRQoL), and substantial financial burden. 3 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Exacerbation-related impairment of quality of life and work productivity in severe and very severe chronic obstructive pulmonary disease

Solem¹,

Sun²,

Sudharshan³

et al. 2013

COPD

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“…Previous research shows that the Chinese version of COPD-MSD (Ch-COPD-MSD) has good reliability and validity, which can help clinicians to assess patients with COPD morning symptoms in China. 15 Exacerbations of COPD directly affect the course of the disease, which is associated with a faster rate of lung function decline, 16 impaired health status, 16,17 and increased risk of mortality, 18,19 and is a vital indicator evaluation of the longterm risk of poor prognosis. 20 Thus, reducing the risk of exacerbations is a crucial goal of COPD therapy.…”

Section: Introductionmentioning

confidence: 99%

<p>The Relationship Between Morning Symptoms and the Risk of Future Exacerbations in COPD</p>

Sun

Cheng

et al. 2020

COPD

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Background: The morning is the most troublesome time of day for patients with chronic obstructive pulmonary disease (COPD). However, the association of morning symptoms and COPD exacerbations in longitudinal follow-up has not been studied. In this study, we mainly aimed to investigate the relationship between morning symptoms and exacerbations over a one-year follow-up period. And the secondary aim was an investigation of the association between morning symptoms and baseline clinical features. Patients and Methods: Ninety-two patients with stable COPD provided the baseline information. Morning symptoms were assessed with the Chinese version of Chronic Obstructive Pulmonary Disease Morning Symptom Diary (Ch-COPD-MSD); the median morning symptoms score was used as a cutoff to separate the study cohort in two groups. Modified Medical Research Council (mMRC), COPD assessment test (CAT), and Clinical COPD Questionnaire (CCQ) were used and exacerbation history of the previous year was recorded. Seventy-eight patients (84.8%) completed the longitudinal follow-up of exacerbations. Results: The median morning symptoms score was 30 in stable COPD patients. Morning symptoms severity was different between COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups (p<0.001). Patients with high morning symptoms (score > 30) had higher scores of mMRC, CAT, and CCQ (p< 0.05). CAT score was an independent risk factor of morning symptoms. During follow-up, 41% of patients experienced ≥1 exacerbation. The frequency of severe exacerbations was higher in patients with high morning symptoms compared to patients with low morning symptoms (p<0.005). The Ch-COPD-MSD score could predict future severe exacerbations; the area under the ROC curve was 0.751 (95% CI: 0.633-0.868, p=0.002). Conclusion: Worse health status and more dyspnea symptom were associated with increased severity of morning symptoms. Morning symptoms were most strongly related to future severe exacerbations and could predict future exacerbations in patients with COPD.

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“…31,32 Despite the promising improvements in lung function demonstrated with current treatments, the question remains whether interventions that significantly improve FEV1 are also associated with improvements in other outcome measures. Several studies have demonstrated a significant relationship between poor lung function and a decline in health status in patients with COPD; [33][34][35][36][37][38] however, there is limited evidence that changes in lung function associated with a therapeutic intervention correlate with changes in patient-centred outcomes. In a recent analysis, pooled data from three indacaterol studies (12,26, and 52 weeks in duration) were used to examine relationships between change from baseline of FEV1 and clinical outcomes (dyspnoea (TDI score), health status (SGRQ score) and exacerbations).…”

Section: Laba/lama Combination Therapy and The Future Of Copd Managementmentioning

confidence: 99%

Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes

Molen

Cazzola

2012

Primary Care Respiratory Journal

103

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Bronchodilators are central to the management of chronic obstructive pulmonary disease (COPD). Clinical studies combining different classes of bronchodilators, in particular a long-acting muscarinic antagonist (LAMA) and a long-acting β2-agonist (LABA), have demonstrated greater improvements in lung function (forced expiratory volume in 1 second, FEV1) in patients with COPD than monotherapy. FEV1 has served as an important diagnostic measurement of COPD, and the majority of clinical studies of currently available pharmacotherapies grade effectiveness of treatment regimens based on improvements in FEV1. However, FEV1 alone may not adequately reflect the overall health status of the patient. Published evidence suggests that LABA/LAMA combination therapies demonstrate greater improvements in patient-centred outcomes such as dyspnoea, symptoms, rescue medication use, and quality of life than individual drugs used alone. Evaluating patient-centred outcomes associated with COPD is likely to play an important role in future research as a measure of overall treatment effectiveness. Raising awareness of the importance of outcomes beyond lung function alone, particularly in primary care where most patients initially present themselves for medical evaluation, should form a fundamental part of a more holistic approach to COPD management.

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Impact of frequency of COPD exacerbations on pulmonary function, health status and clinical outcomes

Cited by 69 publications

References 32 publications

Exacerbation-related impairment of quality of life and work productivity in severe and very severe chronic obstructive pulmonary disease

Exacerbation-related impairment of quality of life and work productivity in severe and very severe chronic obstructive pulmonary disease

<p>The Relationship Between Morning Symptoms and the Risk of Future Exacerbations in COPD</p>

Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes

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