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Published ahead of print on February 27, 2004, doi:10.1164/rccm.200310-1443OC
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American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 1298-1303, (2004)
© 2004 American Thoracic Society

Original Article

Early Therapy Improves Outcomes of Exacerbations of Chronic Obstructive Pulmonary Disease

Tom M. A. Wilkinson, Gavin C. Donaldson, John R. Hurst, Terence A. R. Seemungal and Jadwiga A. Wedzicha

Academic Unit of Respiratory Medicine, St. Bartholomew's and the Royal London School of Medicine, St. Bartholomew's Hospital, London, United Kingdom

Correspondence and requests for reprints should be addressed to Jadwiga A. Wedzicha, M.D., Academic Unit of Respiratory Medicine, Dominion House, St. Bartholomew's Hospital, London EC1A 7BE, UK. E mail: j.a.wedzicha{at}qmul.ac.uk

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) FEV1 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.

Key Words: chronic obstructive pulmonary disease • exacerbations • therapy




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