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Impact of COPD exacerbations leading to hospitalization on general and disease-specific quality of life

      Highlights

      • Acute exacerbations negatively impact quality of life in patients with COPD.
      • The relative impact of hospitalized exacerbations on quality of life is not clear.
      • Quality of life and symptom scores were severely reduced in all COPD patients at baseline.
      • Patients with hospitalized exacerbations did not experience improvements in quality of life.
      • Patients without exacerbations experienced improved disease-specific quality of life symptom scores.

      Abstract

      Rationale

      Acute exacerbations negatively impact quality of life in patients with chronic obstructive pulmonary disease (COPD), but the impact of hospitalized exacerbations on quality of life is not clear. We hypothesized that patients with hospitalized exacerbations would benefit from hospitalization and experience improvement in general and disease-specific quality of life (as measured by the St. George's respiratory questionnaire (SGRQ) and the medical outcomes study 36-item short form health survey (SF-36)) compared to those without exacerbations, or with non-hospitalized acute exacerbations.

      Methods

      1219 COPD patients enrolled in either the simvastatin for the prevention of exacerbations in moderate-to severe COPD Trial (STATCOPE) or azithromycin for prevention of exacerbations of COPD trial (MACRO) were analyzed. Demographic information, spirometry, and symptom scores were noted at baseline. Exacerbation events and changes in quality of life scores were assessed over a mean of 538 days of follow-up.

      Results

      Of patients studied, 25.6% were hospitalized, 44.0% had at least one outpatient exacerbation, and 30.4% had no exacerbation. Baseline SGRQ and SF-36 scores were severely impaired in all groups studied. Over time, SF-36 scores did not change significantly between groups. SGRQ symptom domain scores improved in other groups but did not improve in those hospitalized for a COPD exacerbation.

      Conclusions

      At baseline, patients hospitalized for acute exacerbations of COPD had more impaired quality of life scores. Over time, SGRQ symptom domain scores improved in other groups but did not in those who were hospitalized. Other measurements of quality of life were not improved by hospitalization for COPD.

      Keywords

      Abbreviations:

      AECOPD (Acute Exacerbations of COPD), ATS (American Thoracic Society), BMI (Body Mass Index), CI (Confidence Interval), COPD (Chronic Obstructive Pulmonary Disease), ERS (European Respiratory Society), FEV1 (Forced Expiratory Volume in 1 Second), GOLD (Global Initiative for Chronic Obstructive Lung Disease), ICS (Inhaled Corticosteroid), LABA (Long-Acting Beta 2 Agonist), LAMA (Long-Acting Muscarinic Antagonist), MACRO (Azithromycin for prevention of exacerbations of COPD), MCID (Minimal Clinically Important Difference), SABA (Short-Acting Beta 2 Agonist), SD (Standard Deviation), SGRQ (St. George's Respiratory Questionnaire), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), STATCOPE (The Simvastatin for the Prevention of Exacerbations in Moderate-To Severe COPD Trial)
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