Effect of Exacerbation on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Exacerbations occur commonly in patients with moderate or severe chronic obstructive pulmonary disease (COPD) but factors affecting their severity and frequency or effects on quality of life are unknown. We measured daily peak expiratory flow rate (PEFR) and daily respiratory symptoms for 1 yr in 70 COPD patients (52 male, 18 female, mean age [+/- SD] 67.5 +/- 8.3 yr, FEV1 1.06 +/- 0.45 L, FVC 2.48 +/- 0.82 L, FEV1/FVC 44 +/- 15%, FEV1 reversibility 6.7 +/- 9.1%, PaO2 8.8 +/- 1.1 kPa). Quality of life was measured by the St. George's Respiratory Questionnaire (SGRQ). Exacerbations (E) were assessed at acute visit (reported exacerbation) or from diary card data each month (unreported exacerbation). In 61 (87%) patients there were 190 exacerbations (median 3; range, 1 to 8) of which 93 (51%) were reported. There were no differences in major symptoms (increase in dyspnea, sputum volume, or purulence) or physiological parameters between reported and unreported exacerbations. At exacerbation, median peak flow fell by an average of 6.6 L/min (p = 0.0003). Using the median number of exacerbations as the cutoff point, patients were classified as infrequent exacerbators (E = 0 to 2) or frequent exacerbators (E = 3 to 8). The SGRQ Total and component scores were significantly worse in the group that had frequent exacerbations: SGRQ Total score (mean difference = 14.8, p < 0.001), Symptoms (23.1, p < 0.001), Activities (12.2, p = 0.003), Impacts (13.9, p = 0.002). However there was no difference between frequent and infrequent exacerbators in the fall in peak flow at exacerbation. Factors predictive of frequent exacerbations were daily cough (p = 0.018), daily wheeze (p = 0.011), and daily cough and sputum (p = 0.009) and frequent exacerbations in the previous year (p = 0.001). These findings suggest that patient quality of life is related to COPD exacerbation frequency.

Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation

“…However, the study was not powered to detect a difference for this outcome. This study has major clinical relevance because readmission avoidance is beneficial to the patient in terms of preservation of lung function and health-related quality of life 25 as well as providing a direct and indirect cost saving.…”

Exacerbations of chronic obstructive pulmonary disease — A patients' perspective

“…More recently, health status and exacerbations have become more important variables [1,2], the focus of the latter being on reducing their frequency, their cost to health care providers and their impact on the individual [3]. These variables -health status and exacerbations -are inextricably linked since it has been shown that the incidence of frequent exacerbations is associated with reduction in quality of life, increased symptoms, reduction in activity, and reports of COPD being the highest factor impacting on patients' daily lives [2]. And yet, despite these effects, there is evidence that patients under-report exacerbations [2].…”

Detection of rhinovirus in induced sputum at exacerbation of chronic obstructive pulmonary disease

“…COPD exacerbations have major effects on health status [3], are associated with considerable morbidity and mortality, and are frequently triggered by upper respiratory tract infections [4]. These exacerbations are associated with increased airway inflammation and airflow obstruction [4,5].…”