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Am J Respir Crit Care Med. 2015 Oct 15;192(8):943-50. doi: 10.1164/rccm.201412-2269OC.

Impact of Prolonged Exacerbation Recovery in Chronic Obstructive Pulmonary Disease.

Author information

1
1 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and.
2
2 MRC Biostatistics Unit, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, United Kingdom.

Abstract

RATIONALE:

Exacerbations are important and heterogeneous events in the natural history of chronic obstructive pulmonary disease (COPD).

OBJECTIVES:

To examine the consequences of prolonged exacerbation recovery in patients with COPD.

METHODS:

A cohort of 384 patients with COPD (FEV1 % predicted 45.8 [SD, 16.6] and a median exacerbation rate of 2.13 per year [interquartile range, 1.0-3.2]) were followed for 1,039 days (interquartile range, 660-1,814) between October 1995 and January 2013. Patients recorded daily worsening of respiratory symptoms and peak expiratory flow (PEF), and when stable underwent spirometry every 3 months, and completed the St. George's Respiratory Questionnaire annually. Exacerbations were diagnosed as 2 consecutive days with one major symptom plus another respiratory symptom. Exacerbation duration was defined as the time from onset to the day preceding 2 consecutive symptom-free days and recovery in PEF as return to preexacerbation levels.

MEASUREMENTS AND MAIN RESULTS:

A total of 351 patients had one or more exacerbations. Patients with a longer symptom duration (mean, 14.5 d) had a worse St. George's Respiratory Questionnaire total score (0.2 units per 1 day; P = 0.040). A longer symptomatic duration was associated with a shorter interval between exacerbation recovery and onset of the next exacerbation (hazard ratio, 1.004; P = 0.013). For 257 (7.3%) exacerbations, PEF did not recover within 99 days. These exacerbations were associated with symptoms of a viral infection (cold and sore throat). Patients with these nonrecovered exacerbations showed a 10.8 ml/yr (P < 0.001) faster decline in FEV1.

CONCLUSIONS:

Prolonged exacerbation symptomatic duration is associated with poorer health status and a greater risk of a new event. Exacerbations where lung function does not recover are associated with symptoms of viral infections and accelerated decline in FEV1.

KEYWORDS:

COPD; exacerbations; nonrecovery; recovery; risk interval

PMID:
26151174
PMCID:
PMC4642208
DOI:
10.1164/rccm.201412-2269OC
[Indexed for MEDLINE]
Free PMC Article

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