Impact of COPD exacerbations

Abstract

Background: Acute exacerbation in chronic obstructive pulmonary disease (AECOPD) have significant negative impact on patients’ health-status. The bandwidth of day-to-day variability in health-status in patients with stable COPD and impact / amount of change during the event of an AECOPD remains unclear. This study aims at investigating stable day-to-day variability in health-status of patients suffering from chronic obstructive pulmonary disease (COPD) and during an AECOPD. Secondary aim of this study is to investigate the change in health-status during AECOPD. Design: A prospective multi-center cohort study. Methods: Patients (n=40; male=22; FEV1%predicted=60.41 ± 18.67) with a diagnosis of COPD (GOLD I-IV) were asked to record respiratory symptom change during the past 24 hours on a daily diary card. AECOPD was defined using the Anthonisen symptom algorithm. Health-status was measured on three day intervals using the Clinical COPD Questionnaire (CCQ). CCQ scores were retrospectively labeled according to the presence of an AECOPD. Results: Mean follow-up time during the study period was 110.67(± 27,69) days. In total 4427 days (12.13 years) were completed and identified 29 exacerbations (rate:2.39 exacerbations/year). Compared with stable COPD, mean CCQ total score (p=0.004) and the domains function (p=0.009) and symptoms (p=0.000) increased in the event of an AECOPD. There was a clinically and statistically significant impact on health-status directly after AECOPD onset compared with stable periods which was represented in the CCQ total (p<0.001) and domain scores (p<0.05). The maximum deterioration in health-status during AECOPD was beyond day-to-day variations in health-status during stable COPD. Conclusion: This study shows that an AECOPD has major impact on patients’ health-status compared with stable COPD which is beyond day-to-day variability.