The Impact of Severe Exacerbations on Quality of Life and the Clinical Course of Chronic Obstructive Pulmonary Disease

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Abstract

Severe exacerbations of chronic obstructive pulmonary disease (COPD) are morbid events with slow recovery periods. They consume substantial healthcare resources, and they may cause a more rapid reduction in lung function over time. Quality of life (QOL) deteriorates in patients who experience exacerbations, and the more frequent the exacerbations, the more rapid the decline in QOL. Hospitalizations due to exacerbations account for up to 70% of the cost of medical care for patients with COPD. Patients with more severe COPD have more hospitalizations compared with those with less severe disease. A number of therapeutic interventions reduce the number of exacerbations and hospitalizations due to respiratory disease. The long-acting anticholinergic bronchodilator tiotropium, influenza vaccination, and possibly case management appear to reduce need for hospitalization substantially. COPD management should include drugs and other interventions that reduce the frequency of exacerbations and minimize their negative impact on the clinical course of the disease.

Section snippets

Clinical effects of exacerbations

COPD exacerbations have serious clinical consequences. The reduction in lung function and associated symptoms seen at the onset of an exacerbation cause deterioration in patient quality of life (QOL) and a need for healthcare interventions, such as unscheduled medical visits and hospitalizations. Repeated exacerbations may accelerate the underlying severity of the disease by causing a more rapid rate of decline in lung function over time.

An increase in dyspnea is the most common symptom of

Exacerbations and progression of the underlying disease

There is some evidence to suggest that frequent exacerbations may accelerate the rate of decline of lung function over time in patients with COPD. Investigators in the Lung Health Study inferred exacerbation rates from the number of recorded physician visits for lower respiratory illnesses.16 Patients who continued to smoke had a more rapid decline in FEV1 than did patients who quit. Furthermore, among patients who continued to smoke, the decline in FEV1 was larger with each successive office

Economic impact of severe exacerbations

In addition to their clinical impact, severe exacerbations have major economic consequences. Hospital admissions are by far the largest source of medical expenditures for COPD in the United States, accounting for ≤70% of the total costs of medical care for this disease. Approximately 20% of patients with COPD account for nearly 80% of the total costs.18 In 2003, COPD accounted for >600,000 hospital admissions in the United States, with a mean length of stay of 5 days, a mean cost per

Prevention of chronic obstructive pulmonary disease exacerbations

Because COPD exacerbations and associated hospitalizations for COPD have significant human and economic consequences, their prevention should be a major goal of COPD management. A number of interventions for this purpose are either proved or are under continuing investigation, and these include pharmacologic therapies, immune modulation, and case management.

Both inhaled long-acting bronchodilators and inhaled corticosteroids reduce COPD exacerbation rates. The evidence supporting this

Summary

COPD exacerbations are serious medical events. They adversely affect QOL acutely and recovery occurs only slowly over a period of weeks or months. Not surprisingly, QOL deteriorates more rapidly in those patients with frequent exacerbations. Exacerbations may also be associated with a more rapid decline in lung function over time, thus accelerating the natural progression of the disease. Exacerbations have a huge economic impact. Patients with more severe exacerbations frequently seek medical

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