help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Published ahead of print on February 27, 2004, doi:10.1164/rccm.200310-1443OC
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online  Supplement
Right arrow All Versions of this Article:
200310-1443OCv1
169/12/1298    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wilkinson, T. M. A.
Right arrow Articles by Wedzicha, J. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wilkinson, T. M. A.
Right arrow Articles by Wedzicha, J. A.
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




This article has been cited by other articles:


Home page
 ThoraxHome page
J. A Wedzicha
Antibiotics at COPD exacerbations: the debate continues
Thorax, November 1, 2008; 63(11): 940 - 942.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
J. K. Quint, R. Baghai-Ravary, G. C. Donaldson, and J. A. Wedzicha
Relationship between depression and exacerbations in COPD
Eur. Respir. J., July 1, 2008; 32(1): 53 - 60.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
L. Langsetmo, R. W. Platt, P. Ernst, and J. Bourbeau
Underreporting Exacerbation of Chronic Obstructive Pulmonary Disease in a Longitudinal Cohort
Am. J. Respir. Crit. Care Med., February 15, 2008; 177(4): 396 - 401.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
M. Cazzola, W. MacNee, F. J. Martinez, K. F. Rabe, L. G. Franciosi, P. J. Barnes, V. Brusasco, P. S. Burge, P. M. A. Calverley, B. R. Celli, et al.
Outcomes for COPD pharmacological trials: from lung function to biomarkers
Eur. Respir. J., February 1, 2008; 31(2): 416 - 469.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
Y. P. de Jong, S. M. Uil, H. P. Grotjohan, D. S. Postma, H. A.M. Kerstjens, and J. W.K. van den Berg
Oral or IV Prednisolone in the Treatment of COPD Exacerbations: A Randomized, Controlled, Double-blind Study
Chest, December 1, 2007; 132(6): 1741 - 1747.
[Abstract] [Full Text] [PDF]

Home page
 Chronic Respiratory DiseaseHome page
Dr. R. Jones
Too little, too late the patients' perspective on education for COPD
Chronic Respiratory Disease, November 1, 2007; 4(4): 189 - 190.
[PDF]

Home page
 Eur Respir JHome page
J. Bourbeau, G. Ford, H. Zackon, N. Pinsky, J. Lee, and G. Ruberto
Impact on patients' health status following early identification of a COPD exacerbation
Eur. Respir. J., November 1, 2007; 30(5): 907 - 913.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
A. Anzueto, S. Sethi, and F. J. Martinez
Exacerbations of Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, October 1, 2007; 4(7): 554 - 564.
[Abstract] [Full Text] [PDF]

Home page
 Chronic Respiratory DiseaseHome page
L. Beaulieu-Genest, D. Chretien, F. Maltais, K. Pelletier, J.-G. Parent, and Y. Lacasse
Self-administered prescriptions of oral steroids and antibiotics in chronic obstructive pulmonary disease: are we doing more harm than good?
Chronic Respiratory Disease, August 1, 2007; 4(3): 143 - 147.
[Abstract] [PDF]

Home page
 ChestHome page
S. J. Carr, R. S. Goldstein, and D. Brooks
Acute Exacerbations of COPD in Subjects Completing Pulmonary Rehabilitation
Chest, July 1, 2007; 132(1): 127 - 134.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
H. Gunen, S. S. Hacievliyagil, O. Yetkin, G. Gulbas, L. C. Mutlu, and E. In
The role of nebulised budesonide in the treatment of exacerbations of COPD
Eur. Respir. J., April 1, 2007; 29(4): 660 - 667.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
C. H Goss and J. L Burns
Exacerbations in cystic fibrosis {middle dot} 1: Epidemiology and pathogenesis
Thorax, April 1, 2007; 62(4): 360 - 367.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
W. R. Perera, J. R. Hurst, T. M. A. Wilkinson, R. J. Sapsford, H. Mullerova, G. C. Donaldson, and J. A. Wedzicha
Inflammatory changes, recovery and recurrence at COPD exacerbation
Eur. Respir. J., March 1, 2007; 29(3): 527 - 534.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
T. A. R. Seemungal and J. A. Wedzicha
Integrated care: a new model for COPD management?
Eur. Respir. J., July 1, 2006; 28(1): 4 - 6.
[Full Text] [PDF]

Home page
 ChestHome page
R. Kessler, E. Stahl, C. Vogelmeier, J. Haughney, E. Trudeau, C.-G. Lofdahl, and M. R. Partridge
Patient Understanding, Detection, and Experience of COPD Exacerbations: An Observational, Interview-Based Study.
Chest, July 1, 2006; 130(1): 133 - 142.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
A. Casas, T. Troosters, J. Garcia-Aymerich, J. Roca, C. Hernandez, A. Alonso, F. del Pozo, P. de Toledo, J. M. Anto, R. Rodriguez-Roisin, et al.
Integrated care prevents hospitalisations for exacerbations in COPD patients
Eur. Respir. J., July 1, 2006; 28(1): 123 - 130.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
L. Nici, C. Donner, E. Wouters, R. Zuwallack, N. Ambrosino, J. Bourbeau, M. Carone, B. Celli, M. Engelen, B. Fahy, et al.
American thoracic society/european respiratory society statement on pulmonary rehabilitation.
Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1390 - 1413.
[Full Text] [PDF]

Home page
 ThoraxHome page
R Rodriguez-Roisin
COPD exacerbations {middle dot} 5: Management.
Thorax, June 1, 2006; 61(6): 535 - 544.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
J. A. Wedzicha and T. Wilkinson
Impact of Chronic Obstructive Pulmonary Disease Exacerbations on Patients and Payers
Proceedings of the ATS, May 1, 2006; 3(3): 218 - 221.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
A. Papi, F. Luppi, F. Franco, and L. M. Fabbri
Pathophysiology of Exacerbations of Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, May 1, 2006; 3(3): 245 - 251.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
P. S. Burge
Prevention of Exacerbations: How Are We Doing and Can We Do Better?
Proceedings of the ATS, May 1, 2006; 3(3): 257 - 261.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
S Scott, P Walker, and P M A Calverley
COPD exacerbations {middle dot} 4: Prevention
Thorax, May 1, 2006; 61(5): 440 - 447.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
T. M. A. Wilkinson, G. C. Donaldson, S. L. Johnston, P. J. M. Openshaw, and J. A. Wedzicha
Respiratory Syncytial Virus, Airway Inflammation, and FEV1 Decline in Patients with Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., April 15, 2006; 173(8): 871 - 876.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
T. M. A. Wilkinson, J. R. Hurst, W. R. Perera, M. Wilks, G. C. Donaldson, and J. A. Wedzicha
Effect of Interactions Between Lower Airway Bacterial and Rhinoviral Infection in Exacerbations of COPD.
Chest, February 1, 2006; 129(2): 317 - 324.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
G C Donaldson and J A Wedzicha
COPD exacerbations {middle dot} 1: Epidemiology
Thorax, February 1, 2006; 61(2): 164 - 168.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
P. Mallia and S. L. Johnston
Mechanisms and Experimental Models of Chronic Obstructive Pulmonary Disease Exacerbations
Proceedings of the ATS, November 1, 2005; 2(4): 361 - 366.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
J. Haughney, M. R. Partridge, C. Vogelmeier, T. Larsson, R. Kessler, E. Stahl, R. Brice, and C-G. Lofdahl
Exacerbations of COPD: quantifying the patient's perspective using discrete choice modelling
Eur. Respir. J., October 1, 2005; 26(4): 623 - 629.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
R. Rodriguez-Roisin
Is this the beginning of unravelling the puzzle of COPD exacerbations?
Eur. Respir. J., September 1, 2005; 26(3): 376 - 378.
[Full Text] [PDF]

Home page
 ChestHome page
S. Chodosh
Clinical Significance of the Infection-FreeInterval in the Management of Acute Bacterial Exacerbations of Chronic Bronchitis
Chest, June 1, 2005; 127(6): 2231 - 2236.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
L. Fabbri, S. P. Peters, I. Pavord, S. E. Wenzel, S. C. Lazarus, W. MacNee, F. Lemaire, and E. Abraham
Allergic Rhinitis, Asthma, Airway Biology, and Chronic Obstructive Pulmonary Disease in AJRCCM in 2004
Am. J. Respir. Crit. Care Med., April 1, 2005; 171(7): 686 - 698.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
G. C. Donaldson, T. M. A. Wilkinson, J. R. Hurst, W. R. Perera, and J. A. Wedzicha
Exacerbations and Time Spent Outdoors in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., March 1, 2005; 171(5): 446 - 452.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
S. Suissa
Early Therapy in Chronic Obstructive Pulmonary Disease: Selection Bias by Exclusion?
Am. J. Respir. Crit. Care Med., February 1, 2005; 171(3): 292 - 292.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
G. C. Donaldson, T. M. A. Wilkinson, J. R. Hurst, T. A. R. Seemungal, and J. A. Wedzicha
Early Therapy in Chronic Obstructive Pulmonary Disease: Selection Bias by Exclusion?
Am. J. Respir. Crit. Care Med., February 1, 2005; 171(3): 292 - 292.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
G. L. Snider
Exacerbations of Chronic Obstructive Pulmonary Disease: Should Self-Management Be Used?
Am. J. Respir. Crit. Care Med., October 15, 2004; 170(8): 920 - 920.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
P. Paggiaro
Does Early Treatment of Exacerbation Improve Outcome in Chronic Obstructive Pulmonary Disease?
Am. J. Respir. Crit. Care Med., June 15, 2004; 169(12): 1267 - 1268.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2004 American Thoracic Society 		  2009/2010 ATS Fellows Career Development Awards