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05-05-2010 | Respiratory | Article

Unreported, untreated COPD exacerbations linked to reduced HRQoL


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MedWire News: Two or more unreported exacerbations are associated with reduced health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), study results show.

“Previous studies have shown that at least half of all COPD exacerbations identified by symptom worsening were not medically reported, and, therefore, left untreated,” explain C Wang (Capital Medical University, Beijing, China) and colleagues.

But they add that the intermediate-to-long-term effects of unreported COPD exacerbations on a patients’ HRQoL are not known.

To investigate, the team studied 491 COPD patients who were aged an average of 65 years and had an FEV1 of less than 80% of the predicted value.

The participants were interviewed every month for 1 year to document the occurrence of COPD exacerbations, defined as a worsening of at least one symptom (increased sputum, change in sputum color or purulence, and increased dyspnea) for 48 hours. They were also asked whether they had reported such exacerbations to their physician.

In addition, the patients completed the St George's Respiratory Questionnaire (SGRQ) at baseline and at the end of the 1-year study to indentify any changes in HRQoL.

In total, 466 unreported and 410 reported exacerbations were recorded during the course of the study.

Analysis revealed no significant reduction in HRQoL in patients with just one unreported exacerbation, at a mean difference in SGRQ scores of just 1.22 points between baseline and the end of the study. Indeed, patients with just one unreported exacerbation had similar HRQoL at the end of the study as those who experienced no exacerbations.

However, patients with two or more unreported exacerbations experienced a significant worsening in HRQoL, as indicated by a mean change of 4.61 points in SGRQ scores between baseline and the end of the study period.

Wang and team conclude in the European Respiratory Journal: “More than one unreported exacerbation was associated with a significantly (both statistically and clinically) worse HRQoL change at 1 year after adjusting for known confounders.”

They add: “The intermediate-to-long-term HRQoL impacts of both unreported and reported exacerbations call for further investigations of modifiable risk factors for COPD exacerbations, as well as for interventional strategies that prevent the occurrence of COPD exacerbations.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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