Key Point:

Prompt treatment of COPD exacerbations can shorten recovery time, avoid hospitalization, and improve health-related quality of life.

LONDON—Can treating COPD exacerbations soon after symptoms start shorten the duration of impairment? According to investigators at St. Bartholomew’s Hospital in London, the answer is yes. “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.”¹

The researchers followed 128 COPD patients for six years and found that patients who recognized the symptoms of an exacerbation and sought prompt treatment fared better than those whose exacerbations went untreated.

Patients were asked about their usual respiratory symptoms and long-term use of inhaled and oral corticosteroids. Patients completed diary cards, recording their peak expiratory flow and any changes in symptoms. Changes indicative of an exacerbation (major symptoms) included increased dyspnea and sputum purulence or volume. Minor symptoms included colds, wheeze, sore throat, or cough. Patients visited the study clinic every three months.

An exacerbation was defined as the presence, for at least two days, of two major symptoms or one major and one minor symptom. The time between exacerbation onset and physician consultation was calculated, as was the time to recovery to baseline symptom levels. The severity of symptoms was gauged by the difference between the average daily baseline symptom count and the number of symptoms at onset of the exacerbation.

Patients experienced a total of 1,099 exacerbations. Of these, 658 were reported to either the study team or to a primary care physician. The remaining 441 exacerbations were determined from diary cards but not otherwise reported. COPD symptoms increased during exacerbations (Table).

EARLIER TREATMENT, FASTER RECOVERY

Two hundred sixty-six exacerbations were treated with oral corticosteroids, 600 were treated with antibiotics, and 241 were treated with both. The median time between symptom onset and treatment was 3.69 days, and the median total recovery time was 10.7 days (6.9 days with treatment). Treatment with oral prednisolone shortened recovery time by 2.63 days compared to recovery in patients who did not receive prednisolone. Early treatment was associated with a quicker recovery. Recovery time is an important measure of the severity of a COPD exacerbation, the authors pointed out.

They also noted that patients with more severe symptoms had longer exacerbations and also tended to report symptoms earlier. However, after adjusting for this potential confounder, the relationship between early treatment and recovery became more pronounced.

During the study, 6.4% of exacerbations required hospitalization. Patients who did not seek treatment at onset of exacerbation symptoms were more likely to be hospitalized than those who reported exacerbations and sought treatment.

Patients who did not report their symptoms were also more likely to visit the emergency department for treatment. The researchers speculated that these patients may be less aware of the significance of symptom changes or may underestimate their severity.

Factors that influence whether a patient reports COPD symptoms are complex, with both physical and psychological components. Not reporting COPD exacerbations can adversely affect health-related quality of life. On the other hand, the authors wrote, poor health-related quality of life may lessen the likelihood of a patient seeking treatment. Increasing patient awareness and timely use of existing treatments can improve COPD management, they concluded.

—Gale Jurasek

Reference
1. Wilkinson TMA, Donaldson GC, Hurst JR, et al. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169:1298-1303.

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