Day-to-day measurement of patient-reported outcomes in exacerbations of chronic obstructive pulmonary disease

Abstract

BackgroundExacerbations of chronic obstructive pulmonary disease (COPD) are a major burden to patients and to society. Little is known about the possible role of day-to-day patient-reported outcomes during an exacerbation. This study aims to describe the day-to-day course of patient-reported health status during exacerbations of COPD and to assess its value in predicting clinical outcomes.MethodsData from two randomized controlled COPD exacerbation trials (n = 210 and n = 45 patients) were used to describe both the feasibility of daily collection of and the day-to-day course of patient-reported outcomes during outpatient treatment or admission to hospital. In addition to clinical parameters, the BORG dyspnea score, the Clinical COPD Questionnaire (CCQ), and the St George’s Respiratory Questionnaire were used in Cox regression models to predict treatment failure, time to next exacerbation, and mortality in the hospital study.ResultsAll patient-reported outcomes showed a distinct pattern of improvement. In the multivariate models, absence of improvement in CCQ symptom score and impaired lung function were independent predictors of treatment failure. Health status and gender predicted time to next exacerbation. Five-year mortality was predicted by age, forced expiratory flow in one second % predicted, smoking status, and CCQ score. In outpatient management of exacerbations, health status was found to be less impaired than in hospitalized patients, while the rate and pattern of recovery was remarkably similar.ConclusionDaily health status measurements were found to predict treatment failure, which could help decision-making for patients hospitalized due to an exacerbation of COPD.

Course of COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores during recovery from exacerbations of chronic obstructive pulmonary disease

“…Furthermore, a recent work in which the patients were monitorised daily during an exacerbation, showed that the absence of improvement in CCQ symptoms score and impaired lung function were independent predictors of treatment failure [28]. Concurrent with our results, the authors find the rate and pattern of recovery very similar in outpatients and inpatients [28]. …”

“…Using weekly measurements, an impairment of 0.20 points had a positive predictive value of 43.5% and a negative predictive value of 90.8% for the onset of an exacerbation in the next week [27]. Furthermore, a recent work in which the patients were monitorised daily during an exacerbation, showed that the absence of improvement in CCQ symptoms score and impaired lung function were independent predictors of treatment failure [28]. Concurrent with our results, the authors find the rate and pattern of recovery very similar in outpatients and inpatients [28].…”

COPD management: role of symptom assessment in routine clinical practice

“…There is strong supporting evidence for the reliability, validity, and responsiveness of the CCQ 42,55. The CCQ has also been shown to be very sensitive to clinical improvement after smoking cessation,16,56 and during and after exacerbations 57. Further, contrary to expectations, the total CCQ score correlates well with lung function (as assessed by FEV 1 percent predicted) in patients with COPD, although this relationship was limited to patients with GOLD airflow limitation grades 1–3 16.…”

Health status measured by the Clinical COPD Questionnaire (CCQ) improves following post-acute pulmonary rehabilitation in patients with advanced COPD: a prospective observational study

“…Although this score is similar to our results, the time at which the CCQ score was measured is different, as we measured the CCQ on admission to the SNF. In the study by Kocks et al , 21 the CCQ total score improved rapidly during hospital stay, with a mean score of 2.3 on day 7. These results seem to confirm that our population indeed consisted of those patients who failed to recover during hospital stay.…”

“…This can be explained by the fact that our population suffered from a recent exacerbation and that exacerbations have a negative effect on health status. Recently, Kocks et al 21 reported data from two randomised controlled COPD exacerbation trials on the day-to-day course of patient-reported health status (as measured with the CCQ) during exacerbations. They reported results from 210 COPD patients admitted to hospital for an acute exacerbation (mean age 70.6 years, mean FEV 1 : 37% of predicted); the CCQ total score on admission to the hospital was 3.3 (±0.93).…”