Chest
Volume 131, Issue 3, March 2007, Pages 696-704
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Original Research
Impact of COPD Exacerbations on Patient-Centered Outcomes

https://doi.org/10.1378/chest.06-1610Get rights and content

Abstract

Background:Frequent exacerbations are associated with a faster decline in FEV1, impaired health status, and worse survival. Their impact and temporal relationship with other outcomes such as functional status, dyspnea, and the multidimensional body mass index, obstruction, dyspnea, exercise capacity (BODE) index remain unknown.

Hypothesis:We reasoned that exacerbations affect the BODE index and its components, and that changes in the BODE index could be used to monitor the effect of exacerbations on the host.

Study design:Prospective observational study in a Veterans Affairs medical center.

Methods:We studied 205 patients with COPD (mean [± SD] FEV1, 43 ± 15% predicted), and recorded the body mass index, FEV1percent predicted, modified Medical Research Council dyspnea scale, 6-min walk distance, and the BODE index at baseline, during the exacerbation, and at 6, 12, and 24 months following the first episode, and documented all exacerbations for 2 years after the first acute exacerbation.

Results:From the cohort, 130 patients (63%) experienced 352 exacerbations or (0.85 exacerbations per patient per year); 48 patients (23%), experienced one episode, 82 patients (40%) experienced 2 or more exacerbations, and 50 patients required hospitalization. At study entry, exacerbators had a worse mean baseline BODE index score (4.2 ± 2.1 vs 3.57 ± 2.3, respectively; p < 0.03). The BODE index score worsened by 1.38 points during the exacerbation, and remained 0.8 and 1.1 points above baseline at 1 and 2 years, respectively. There was little change in BODE index score at 2 years in nonexacerbators.

Conclusion:COPD exacerbations negatively impact on the BODE index and its components. The BODE index is a sensitive tool used to assess the impact of exacerbations and to monitor COPD disease progression.

Section snippets

Patients

Patients with a diagnosis of COPD, according to the criteria of the American Thoracic Society (ATS),25were recruited between June 2001 and June 2004, and were followed up until May 2006 at one of the BODE Cohort Study Centers. The inclusion/exclusion criteria have been previously published.16The study was prospective and observational, and included 205 consecutive patients. All patients signed a consent form, and the protocol was approved by the Internal Review Board.

Measurements

Pulmonary function tests26

Results

The cohort consisted primarily of men. A total of 1.5% of patients were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I, 32% in GOLD stage II, 45% in GOLD stage III, and 21.5% in GOLD stage IV. One hundred thirty patients experienced exacerbations; 75 patients who did not experience exacerbations during the same period served as control subjects. The median exacerbation rate was 1 episode per patient; therefore we defined those patients experiencing two or more

Discussion

This study provides us with the following three important findings: first, the BODE index captures short-term changes during moderate exacerbations. Second, exacerbations are important determinants of the rate of change in BODE index over time. Third, patients who do not experience an exacerbation have little change in BODE index scores.

It is known that exacerbations contribute to a further loss of FEV1,4, 10a worsening of HRQOL,11a high socioeconomic burden,6, 8and an increase in mortality.9,

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    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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