This Article Full Text Full Text (PDF) All Versions of this Article: chest.07-1692v1 chest.07-1692v2 133/1/34    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vijayasaratha, K. Articles by Stockley, R. A. Search for Related Content PubMed PubMed Citation Articles by Vijayasaratha, K. Articles by Stockley, R. A.

Reported and Unreported Exacerbations of COPD^*

Analysis by Diary Cards

^* From the Lung Investigations Unit, University Hospital Birmingham NHS Trust, Birmingham, UK.

Correspondence to: Robert A. Stockley, MD, DSc, Director, Research and Development, Lung Investigations Unit, University Hospital Birmingham NHS Trust, Birmingham, UK; e-mail: rob.stockley{at}bham.ac.uk

Abstract

Background: Exacerbations of COPD are a major cause of morbidity and mortality; however, it has been reported that nearly half of such episodes based on symptoms are classified as "unreported" (no change in treatment), although the reasons are unknown.

Method: We used a symptom-based diary card to study 155 symptom-defined episodes (74 episodes in which treatment was not changed) in 19 patients with ₁-antitrypsin deficiency.

Results: The average length for the untreated episodes (time to resolution of all symptoms) was shorter than treated episodes (mean ± SE, 8.3 ± 1.0 days vs 16.1 ± 1.6 days; p < 0.001). Of most importance, the patients documented feeling less well than usual for an average of only 1.9 ± 0.4 days for untreated episodes, vs 11.7 ± 1.7 days for treated episodes (p < 0.001). We developed a scoring system based on the symptoms of breathlessness, well-being, sputum color, and volume to quantify the episodes. The scores were higher for the first day of the treated episodes than untreated episodes (33.5 ± 0.6 vs 28.4 ± 0.5, respectively; p < 0.001), and the treated episodes had total scores that exceeded the baseline more than the untreated episodes (160.5 ± 20.0 vs 43.4 ± 6.6; p < 0.001). Antibiotics or steroids were started 4.4 ± 0.5 days and 4.9 ± 1.8 days on average, respectively, after symptoms changed, suggesting that the early return of well-being to normal is central to the episodes described as unreported (untreated) by others.

Conclusion: The diary card analysis described here provides a tool to document therapies that influence health-care–dependent exacerbations of COPD.

Key Words: daily diary cards • reported and unreported exacerbations in COPD