Prediction and course of symptoms and lung function around an exacerbation in chronic obstructive pulmonary disease

Maarten Van Den Berge,Jan A Van Noord,Ad Jm Schreurs,Jacques Phm Creemers,Thys Van Der Molen,Emiel Fm Wouters,Wim Cj Hop,Dirkje S Postma

doi:10.1186/1465-9921-13-44

Abstract

BackgroundFrequent exacerbations induce a high burden to Chronic Obstructive Pulmonary Disease (COPD). We investigated the course of exacerbations in the published COSMIC study that investigated the effects of 1-year withdrawal of fluticasone after a 3-month run-in treatment period with salmeterol/fluticasone in patients with COPD.MethodsIn 373 patients, we evaluated diary cards for symptoms, Peak Expiratory Flow (PEF), and salbutamol use and assessed their course during exacerbations.ResultsThere were 492 exacerbations in 224 patients. The level of symptoms of cough, sputum, dyspnea and nocturnal awakening steadily increased from 2 weeks prior to exacerbation, with a sharp rise during the last week. Symptoms of cough, sputum, and dyspnea reverted to baseline values at different rates (after 4, 4, and 7 weeks respectively), whereas symptoms of nocturnal awakening were still increased after eight weeks. The course of symptoms was similar around a first and second exacerbation. Increases in symptoms and salbutamol use and decreases in PEF were associated with a higher risk to develop an exacerbation, but with moderate predictive values, the areas under the receiver operating curves ranging from 0.63 to 0.70.ConclusionsExacerbations of COPD are associated with increased symptoms that persist for weeks and the course is very similar between a first and second exacerbation. COPD exacerbations are preceded by increased symptoms and salbutamol use and lower PEF, yet predictive values are too low to warrant daily use in clinical practice.

Highlights

Goals in the management Chronic Obstructive Pulmonary Disease (COPD) are to prevent and control symptoms, to reduce the frequency and severity of exacerbations, and to improve health status and exercise tolerance and prevent disease progression [1]
Prediction of exacerbation by symptoms preceding the first moderate or severe exacerbation We reported previously [14] that females had a 1.4-fold higher exacerbation rate than males (p=0.03) and that baseline Forced expiratory volume in one second (FEV1) % predicted strongly associated with the exacerbation rate, i.e. each 10 points lower value of FEV1 % predicted led to a 1.2-fold increase in exacerbation rate (p
Our study shows that exacerbations of COPD are associated with increased symptoms that persist for weeks

Summary

Introduction

Goals in the management COPD are to prevent and control symptoms, to reduce the frequency and severity of exacerbations, and to improve health status and exercise tolerance and prevent disease progression [1]. Frequent exacerbations induce a high economic, social, and personal burden. Data on exacerbations in COPD are still rather scarce [6,7,8,9], one study suggesting that symptoms resolve within two weeks just as in asthma [7], though another post hoc analysis in a large group of COPD patients suggests that this would take longer [10]. A better understanding of the course of symptoms around COPD exacerbations is important. Frequent exacerbations induce a high burden to Chronic Obstructive Pulmonary Disease (COPD). We investigated the course of exacerbations in the published COSMIC study that investigated the effects of 1-year withdrawal of fluticasone after a 3-month run-in treatment period with salmeterol/fluticasone in patients with COPD

Methods

Results

Conclusion