Defining COPD exacerbations: impact on estimation of incidence and burden in primary care

Abstract

Lung function does not appear to be a valid criterion for assigning COPD management directed at patients with recurrent exacerbation.

Disease severity and symptoms among patients receiving monotherapy for COPD

“…[17][18][19] A recent prospective observational study of COPD patients in the primary care setting (n=201) has suggested that acute exacerbations affect patients across the spectrum of disease severity; O'Reilly et al found an overall exacerbation rate of 77% and that the rate of exacerbation was comparable in those with an FEV 1 greater or less than 50% predicted whether based on symptom diaries or healthcare utilisation. 20 Similarly, we found no relationship between FEV1 and the frequency of mild to moderate acute exacerbations requiring oral corticosteroids and/or antibiotics (overall rate 32%) or severe exacerbations requiring hospitalisation (overall rate 6%). These data, as well as studies suggesting that up to 50% of exacerbations go unreported despite adversely affecting quality of life, suggest that acute exacerbations are a complication of COPD per se, irrespective of severity.…”

Predictive validity of short-form health survey [36 items] scales for chronic obstructive pulmonary disease exacerbation

“…The sampling frame for the study comprised all patients with COPD (with International Classification of Disease-9th Revision codes for COPD, emphysema, or chronic bronchitis) registered with general practitioners within the Wyre Primary Care Trust (WPCT; n ϭ 848) in the United Kingdom. 16 All study methods and documentation were reviewed and approved by the Blackpool, Wyre, and Fylde Local Research Ethics Committee.…”

“…Health care resource use-defined exacerbations were based on taking oral corticosteroids or antibiotics, as reported on the diary cards. 16 HRQoL. The SF-36 was measured at baseline and at 3-month intervals throughout the study year.…”

“…Patients were followed for 1 year after enrollment or until they died (n ϭ 4) or dropped out by no longer returning diary cards. 16 …”

Defining moderate asthma exacerbations in clinical trials based on ATS/ERS joint statement

“…This may be sufficient in clinical practice, but for clinical trials, a more specific, prospective definition is needed to ensure consistency [19]. In chronic obstructive pulmonary disease, data suggest that comparing symptom-defined as opposed to healthcare-defined exacerbation rates results in clinically relevant differences in incidence levels [20] with a resultant impact on economic and care burden [21,22]. Furthermore, patients might adjust medication inappropriately in response to perceived symptom changes [23].…”