Moderate and severe exacerbations have a significant impact on health-related quality of life, utility, and lung function in patients with chronic obstructive pulmonary disease: A meta-analysis.

Abstract

Exacerbations of chronic obstructive pulmonary disease (COPD) may increase the risk of morbidity and mortality as well as pulmonary complications after surgery among patients with COPD. This meta-analysis was designed to explore the impact of moderate and severe exacerbations of COPD on health-related quality of life (HRQoL), utility, and lung function in patients with COPD. The individual impacts of moderate and severe exacerbations on St George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and EuroQoL-5 dimensions 5 level (EQ-5D-5L) scores, and on forced expiratory volume in 1s (FEV1) were assessed. Adjustments were applied to account for differences in study design. Outcomes were measured at specific time points across a 12-month study period, for all patients and for subsets with either no or ≥1 severe exacerbations in the year before study entry. The proximity of each measurement in relation to a specific exacerbation was also assessed. A total of seven randomized clinical trials (RCTs) ≥12-month interventional/observational studies with 18,746 COPD patients were assessed. Overall, 4,483 (24%) patients had ≥1 severe exacerbation in the previous year. Moderate and severe exacerbations were associated with worsening from baseline in SGRQ, CAT, EQ-5D-5L, and FEV1 measures; severe exacerbations had greater impact than moderate exacerbations. Moderate and severe exacerbations have a substantial and lasting impact on HRQoL, utility, and lung function in patients with COPD, highlighting a need for effective exacerbation prevention.