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Published ahead of print on February 27, 2004, doi:10.1164/rccm.200310-1443OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 12, June 2004, 1298-1303

A more recent version of this article appeared on June 15, 2004
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Submitted on October 23, 2003
Accepted on February 25, 2004

Early Therapy Improves Outcomes of Exacerbations of Chronic Obstructive Pulmonary Disease

Tom M. A. Wilkinson1, Gavin C Donaldson1, John R Hurst1, Terence A Seemungal1, and Jadwiga A Wedzicha1*

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

* To whom correspondence should be addressed. E-mail: j.a.wedzicha{at}qmul.ac.uk.

Treatment of COPD exacerbations improves outcomes; however responses to treatment are variable and COPD patients often delay presentation or fail to seek therapy. The impact on exacerbation outcomes, hospitalisation and health status of delaying or failing to seek treatment is poorly understood. We studied a cohort of 128 patients with COPD mean (SD) FEV1 1.07 (0.43)l, between 1996 and 2002. Patients recorded respiratory symptoms daily and reported exacerbations to the outpatient based study team or their primary care physician. 1099 exacerbations were recorded by the patients of which 658 were reported to a physician. The time between exacerbation onset and treatment was median (IQR) 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 faster recovery (regression coefficient 0.42 days/day delay, (CI 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 hospitalisation (rho 0.21, p=0.04). Patient recognition of exacerbation symptoms and prompt treatment improves exacerbation recovery, reduces risks of hospitalisation and is associated with better health-related quality of life.
Key words: COPD EXACERBATIONS THERAPY




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