Impact on patients’ health status following early identification of a COPD exacerbation

Abstract

The current study aimed to assess the impact on patient health status during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).A total of 421 COPD patients were enrolled in a multicentre, single-arm study with a 6-month observational follow-up period. Patients received two inhalations of Symbicort 200 Turbuhaler1 twice a day. Patients were assessed before the run-in period, at baseline and at 1, 3 and 6 months. Patients were instructed to report a change in respiratory symptoms lasting .24 h. This defined an AECOPD. In addition to the initial call, the St George's Respiratory Questionnaire (SGRQ), COPD Control Questionnaire (CCQ), Medical Research Council (MRC) dyspnoea scale and activities of daily living (ADL) were completed at 5-7 and 12-14 days.A group of 176 patients reported at least one AECOPD. Exacerbations were associated with statistically significant mean changes (worsening) in the SGRQ activity and impact domains at onset (mean¡SD 12.1¡18.1 and 14.0¡15.2), during the first (9.8¡19.0 and 9.4¡16.6) and second weeks (3.1¡15.5 and 3.3¡14.7). Clinically significant deterioration in SGRQ impact scores was shown in 71% of patients following early identification, with 55 and 37% during the first and second weeks of an AECOPD, respectively.Acute exacerbation severely impacts on health status. The current study provides valuable information on the change in health status during an acute exacerbation of chronic obstructive pulmonary disease that can be utilised for future trials that evaluate therapeutic intervention.

Roflumilast with long-acting β2-agonists for COPD: influence of exacerbation history

“…These factors include continued smoking, the presence of chronic bronchitis, airway hyperresponsiveness, severity of disease and conditions that increase the risk of COPD exacerbations [23]. Indeed, frequent exacerbations are associated with accelerated loss of lung function, decline in health status and increased mortality, and may be a genuine marker of disease severity [1,24,25]. Thus, current guidelines for the management of COPD recommend escalation of maintenance treatment with increasing severity of disease, beginning with the addition of one or more long-acting bronchodilators.…”

“…n patients with severe chronic obstructive pulmonary disease (COPD), exacerbations are significant events leading to loss of quality of life [1][2][3]. When they are severe or frequent, exacerbations are associated with accelerated decline in lung function and health status, increased mortality and escalating healthcare costs, making their prevention and early treatment a logical focus for management strategies and research [4].…”

Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

“…Reimbursing the costs of smoking cessation therapy has been shown to be both efficacious 26 and cost-effective. 27 Exacerbations are important determinants of prognosis in patients with COPD, and are associated with economic costs, 28 health status, 29,30 lung function, 31 and mortality. 32 Prodromal symptoms of an exacerbation commonly occur up to a week before a discernible reduction in lung function, 33 and about one-half of patients who seek treatment in an emergency department report having had characteristic symptoms for at least 4 days.…”

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations

“…Exacerbations of chronic obstructive pulmonary disease (COPD) accelerate lung function decline, 1 reduce healthrelated quality of life, 2,3 and increase the risk of hospitalisations and death. 4,5 Hence, prevention of exacerbations is an important treatment goal.…”