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Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease

Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease
Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease
Treatment of chronic obstructive pulmonary disease (COPD) exacerbations improves outcomes; however, responses to treatment are variable, and patients with COPD often delay presentation or fail to seek therapy. The impact on exacerbation outcomes, hospitalization, and health status of delaying or failing to seek treatment is poorly understood. We studied between 1996 and 2002 a cohort of 128 patients with COPD, mean (SD) FEV(1) of 1.07 (0.43) L. Patients recorded respiratory symptoms daily and reported exacerbations to the outpatient-based study team or to their primary care physician; 1,099 exacerbations were recorded by the patients, of which 658 were reported to a physician. The time between exacerbation onset and treatment was a median (interquartile range) of 3.69 (2.0-5.57) days, and the exacerbation recovery time was 10.7 (7.0-14.0) days. Earlier treatment was associated with a faster recovery (regression coefficient 0.42 days/day delay) (confidence interval, 0.19-0.65; p < 0.001). Patients who reported a higher proportion of exacerbations for treatment had better health-related quality of life than those patients with more untreated exacerbations (rho = -0.22, p = 0.018). Failure to report exacerbations was associated with an increased risk of emergency hospitalization (rho = 0.21, p = 0.04). Patient recognition of exacerbation symptoms and prompt treatment improves exacerbation recovery, reduces risks of hospitalization, and is associated with a better health-related quality of life.
1073-449X
1298-1303
Wilkinson, Tom M.A.
8c55ebbb-e547-445c-95a1-c8bed02dd652
Donaldson, Gavin C.
48128ec1-2e2d-4ad8-9183-5eb8e70b0cd0
Hurst, John R.
37c4256e-b20f-4df0-ada0-cf3cbd59ecdf
Seemungal, Terence A.R.
d0fd9512-1ebc-47e3-8398-6477c90b358e
Wedzicha, Jadwiga A.
da6d3d6a-9098-4681-9ab6-b5bad0325e52
Wilkinson, Tom M.A.
8c55ebbb-e547-445c-95a1-c8bed02dd652
Donaldson, Gavin C.
48128ec1-2e2d-4ad8-9183-5eb8e70b0cd0
Hurst, John R.
37c4256e-b20f-4df0-ada0-cf3cbd59ecdf
Seemungal, Terence A.R.
d0fd9512-1ebc-47e3-8398-6477c90b358e
Wedzicha, Jadwiga A.
da6d3d6a-9098-4681-9ab6-b5bad0325e52

Wilkinson, Tom M.A., Donaldson, Gavin C., Hurst, John R., Seemungal, Terence A.R. and Wedzicha, Jadwiga A. (2004) Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 169 (12), 1298-1303. (doi:10.1164/rccm.200310-1443OC).

Record type: Article

Abstract

Treatment of chronic obstructive pulmonary disease (COPD) exacerbations improves outcomes; however, responses to treatment are variable, and patients with COPD often delay presentation or fail to seek therapy. The impact on exacerbation outcomes, hospitalization, and health status of delaying or failing to seek treatment is poorly understood. We studied between 1996 and 2002 a cohort of 128 patients with COPD, mean (SD) FEV(1) of 1.07 (0.43) L. Patients recorded respiratory symptoms daily and reported exacerbations to the outpatient-based study team or to their primary care physician; 1,099 exacerbations were recorded by the patients, of which 658 were reported to a physician. The time between exacerbation onset and treatment was a median (interquartile range) of 3.69 (2.0-5.57) days, and the exacerbation recovery time was 10.7 (7.0-14.0) days. Earlier treatment was associated with a faster recovery (regression coefficient 0.42 days/day delay) (confidence interval, 0.19-0.65; p < 0.001). Patients who reported a higher proportion of exacerbations for treatment had better health-related quality of life than those patients with more untreated exacerbations (rho = -0.22, p = 0.018). Failure to report exacerbations was associated with an increased risk of emergency hospitalization (rho = 0.21, p = 0.04). Patient recognition of exacerbation symptoms and prompt treatment improves exacerbation recovery, reduces risks of hospitalization, and is associated with a better health-related quality of life.

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Published date: June 2004

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Local EPrints ID: 47983
URI: http://eprints.soton.ac.uk/id/eprint/47983
ISSN: 1073-449X
PURE UUID: e588f55e-b7ed-49b4-ac4e-30ffd26f704e

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Date deposited: 16 Aug 2007
Last modified: 15 Mar 2024 09:41

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Contributors

Author: Gavin C. Donaldson
Author: John R. Hurst
Author: Terence A.R. Seemungal
Author: Jadwiga A. Wedzicha

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