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

Autor: van den Berge, M., Hop, W.C.J., van der Molen, T., van Noord, J.A., Creemers, J.P.H.M., Schreurs, A.J.M., Wouters, E.F.M., Postma, D.S., the COSMIC (COPD and Seretide: a Multi-Center Intervention and Characterization), study group
Přispěvatelé: Clinical Chemistry, Epidemiology, Groningen Research Institute of Pharmacy, Groningen Research Institute for Asthma and COPD (GRIAC), Pulmonologie, RS: CAPHRI School for Public Health and Primary Care, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting
Rok vydání: 2012
Předmět:
Zdroj: Respiratory Research, 13. BioMed Central Ltd.
Respiratory Research, 13:44. BioMed Central Ltd.
Respiratory Research, 13:44. BioMed Central Ltd
Respiratory Research
Respiratory Research, Vol 13, Iss 1, p 44 (2012)
ISSN: 1465-9921
1465-993X
DOI: 10.1186/1465-9921-13-44
Popis: Background 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 In 373 patients, we evaluated diary cards for symptoms, Peak Expiratory Flow (PEF), and salbutamol use and assessed their course during exacerbations. Results There 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. Conclusions Exacerbations 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.
Databáze: OpenAIRE
Externí odkaz: