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Am. J. Respir. Crit. Care Med., Volume 161, Number 5, May 2000, 1608-1613

Time Course and Recovery of Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

TERENCE A. R. SEEMUNGAL, GAVIN C. DONALDSON, ANGSHU BHOWMIK, DONALD J. JEFFRIES, and JADWIGA A. WEDZICHA

Academic Respiratory Medicine, Physiology, and Virology, St. Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London, United Kingdom

Although exacerbations of chronic obstructive pulmonary disease (COPD) are associated with symptomatic and physiological deterioration, little is known of the time course and duration of these changes. We have studied symptoms and lung function changes associated with COPD exacerbations to determine factors affecting recovery from exacerbation. A cohort of 101 patients with moderate to severe COPD (mean FEV1 41.9% predicted) were studied over a period of 2.5 yr and regularly followed when stable and during 504 exacerbations. Patients recorded daily morning peak expiratory flow rate (PEFR) and changes in respiratory symptoms on diary cards. A subgroup of 34 patients also recorded daily spirometry. Exacerbations were defined by major symptoms (increased dyspnea, increased sputum purulence, increased sputum volume) and minor symptoms. Before onset of exacerbation there was deterioration in the symptoms of dyspnea, sore throat, cough, and symptoms of a common cold (all p < 0.05), but not lung function. Larger falls in PEFR were associated with symptoms of increased dyspnea (p = 0.014), colds (p = 0.047), or increased wheeze (p = 0.009) at exacerbation. Median recovery times were 6 (interquartile range [IQR] 1 to 14) d for PEFR and 7 (IQR 4 to 14) d for daily total symptom score. Recovery of PEFR to baseline values was complete in only 75.2% of exacerbations at 35 d, whereas in 7.1% of exacerbations at 91 d PEFR recovery had not occurred. In the 404 exacerbations where recovery of PEFR to baseline values was complete at 91 d, increased dyspnea and colds at onset of exacerbation were associated with prolonged recovery times (p < 0.001 in both cases). Symptom changes during exacerbation do not closely reflect those of lung function, but their increase may predict exacerbation, with dyspnea or colds characterizing the more severe. Recovery is incomplete in a significant proportion of COPD exacerbations.




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 Eur Respir JHome page
S. Spencer, P.M.A. Calverley, P.S. Burge, and P.W. Jones
Impact of preventing exacerbations on deterioration of health status in COPD
Eur. Respir. J., May 1, 2004; 23(5): 698 - 702.
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 ThoraxHome page
M Miravitlles, M Ferrer, A Pont, R Zalacain, J L Alvarez-Sala, F Masa, H Verea, C Murio, F Ros, and R Vidal
Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study
Thorax, May 1, 2004; 59(5): 387 - 395.
[Abstract] [Full Text] [PDF]

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 Proc Am Thorac SocHome page
R. A. Pauwels
Similarities and Differences in Asthma and Chronic Obstructive Pulmonary Disease Exacerbations
Proceedings of the ATS, April 1, 2004; 1(2): 73 - 76.
[Abstract] [Full Text] [PDF]

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 Proc Am Thorac SocHome page
S. I. Rennard and S. G. Farmer
Exacerbations and Progression of Disease in Asthma and Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, April 1, 2004; 1(2): 88 - 92.
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 Proc Am Thorac SocHome page
J. A. Wedzicha
Role of Viruses in Exacerbations of Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, April 1, 2004; 1(2): 115 - 120.
[Abstract] [Full Text] [PDF]

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 Proc Am Thorac SocHome page
P. M. A. Calverley
Reducing the Frequency and Severity of Exacerbations of Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, April 1, 2004; 1(2): 121 - 124.
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 Infect. Immun.Home page
D. Bogaert, P. van der Valk, R. Ramdin, M. Sluijter, E. Monninkhof, R. Hendrix, R. de Groot, and P. W. M. Hermans
Host-Pathogen Interaction during Pneumococcal Infection in Patients with Chronic Obstructive Pulmonary Disease
Infect. Immun., February 1, 2004; 72(2): 818 - 823.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
G.C. Donaldson, T.A.R. Seemungal, I.S. Patel, S.J. Lloyd-Owen, T.M.A. Wilkinson, and J.A. Wedzicha
Longitudinal changes in the nature, severity and frequency of COPD exacerbations
Eur. Respir. J., December 1, 2003; 22(6): 931 - 936.
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 ChestHome page
N. K. Leidy, S. I. Rennard, J. Schmier, M. K. C. Jones, and M. Goldman
The Breathlessness, Cough, and Sputum Scale: The Development of Empirically Based Guidelines for Interpretation
Chest, December 1, 2003; 124(6): 2182 - 2191.
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 JAMAHome page
B. R. Celli
A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease
JAMA, November 26, 2003; 290(20): 2721 - 2729.
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 ThoraxHome page
M Rudolf
Inpatient management of acute COPD: a cause for concern?
Thorax, November 1, 2003; 58(11): 914 - 915.
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 Am. J. Respir. Crit. Care Med.Home page
Y. Qiu, J. Zhu, V. Bandi, R. L. Atmar, K. Hattotuwa, K. K. Guntupalli, and P. K. Jeffery
Biopsy Neutrophilia, Neutrophil Chemokine and Receptor Gene Expression in Severe Exacerbations of Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., October 15, 2003; 168(8): 968 - 975.
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 ThoraxHome page
A Agusti, W MacNee, K Donaldson, and M Cosio
Hypothesis: Does COPD have an autoimmune component?
Thorax, October 1, 2003; 58(10): 832 - 834.
[Full Text]

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 NEJMHome page
A. J. Busti, M. D. Vervan, S. D. Brouse, J. R. Hurst, G. C. Donaldson, J. A. Wedzicha, G. Rolla, C. Bucca, A. Salloum, T. Y. Elbaage, et al.
Prednisone for Chronic Obstructive Pulmonary Disease
N. Engl. J. Med., September 25, 2003; 349(13): 1288 - 1290.
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M A Spruit, R Gosselink, T Troosters, A Kasran, G Gayan-Ramirez, P Bogaerts, R Bouillon, and M Decramer
Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I
Thorax, September 1, 2003; 58(9): 752 - 756.
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 ThoraxHome page
S Spencer and P W Jones
Time course of recovery of health status following an infective exacerbation of chronic bronchitis
Thorax, July 1, 2003; 58(7): 589 - 593.
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 NEJMHome page
S. D. Aaron, K. L. Vandemheen, P. Hebert, R. Dales, I. G. Stiell, J. Ahuja, G. Dickinson, R. Brison, B. H. Rowe, J. Dreyer, et al.
Outpatient Oral Prednisone after Emergency Treatment of Chronic Obstructive Pulmonary Disease
N. Engl. J. Med., June 26, 2003; 348(26): 2618 - 2625.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
S. Burge and J.A. Wedzicha
COPD exacerbations: definitions and classifications
Eur. Respir. J., June 1, 2003; 21(41_suppl): 46S - 53s.
[Abstract] [Full Text] [PDF]

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 ThoraxHome page
M R Partridge
Patients with COPD: do we fail them from beginning to end?
Thorax, May 1, 2003; 58(5): 373 - 375.
[Full Text]

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 ThoraxHome page
W A Biernacki, S A Kharitonov, and P J Barnes
Increased leukotriene B4 and 8-isoprostane in exhaled breath condensate of patients with exacerbations of COPD
Thorax, April 1, 2003; 58(4): 294 - 298.
[Abstract] [Full Text] [PDF]

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 ThoraxHome page
J Garcia-Aymerich, E Farrero, M A Felez, J Izquierdo, R M Marrades, and J M Anto
Risk factors of readmission to hospital for a COPD exacerbation: a prospective study
Thorax, February 1, 2003; 58(2): 100 - 105.
[Abstract] [Full Text] [PDF]

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 ThoraxHome page
A J White, S Gompertz, and R A Stockley
Chronic obstructive pulmonary disease * 6: The aetiology of exacerbations of chronic obstructive pulmonary disease
Thorax, January 1, 2003; 58(1): 73 - 80.
[Abstract] [Full Text] [PDF]

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 ThoraxHome page
N S Godtfredsen, J Vestbo, M Osler, and E Prescott
Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study
Thorax, November 1, 2002; 57(11): 967 - 972.
[Abstract] [Full Text] [PDF]

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 ThoraxHome page
G C Donaldson, T A R Seemungal, A Bhowmik, and J A Wedzicha
Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease
Thorax, October 1, 2002; 57(10): 847 - 852.
[Abstract] [Full Text] [PDF]

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 ThoraxHome page
I S Patel, T A R Seemungal, M Wilks, S J Lloyd-Owen, G C Donaldson, and J A Wedzicha
Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations
Thorax, September 1, 2002; 57(9): 759 - 764.
[Abstract] [Full Text] [PDF]


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