Detecting exacerbations using the Clinical COPD Questionnaire

BackgroundEarly treatment of COPD exacerbations has shown to be important. Despite a non-negligible negative impact on health related quality of life, a large proportion of these episodes is not reported (no change in treatment). Little is known whether (low burden) strategies are able to capture these unreported exacerbations.MethodsThe Clinical COPD Questionnaire (CCQ) is a short questionnaire with great evaluative properties in measuring health status. The current explorative study evaluates the discriminative properties of weekly CCQ assessment in detecting exacerbations.ResultsIn a multicentre prospective cohort study, 121 patients, age 67.4 ± 10.5 years, FEV1 47.7 ± 18.5% pred were followed for 6 weeks by daily diary card recording and weekly CCQ assessment. Weeks were retrospectively labeled as stable or exacerbation (onset) weeks using the Anthonisen symptom diary-card algorithm. Change in CCQ total scores are significantly higher in exacerbation-onset weeks, 0.35 ± 0.69 compared to -0.04 ± 0.37 in stable weeks (p < 0.001). Performance of the Δ CCQ total score discriminating between stable and exacerbation onset weeks was sufficient (area under the ROC curve 0.75). At a cut off point of 0.2, sensitivity was 62.5 (50.3-73.4), specificity 82.0 (79.3-84.4), and a positive and negative predictive value of 43.5 (35.0-51.0) and 90.8 (87.8-93.5), respectively. Using this cut off point, 22 (out of 38) unreported exacerbations were detected while 39 stable patients would have been false positively 'contacted'.ConclusionsWeekly CCQ assessment is a promising, low burden method to detect unreported exacerbations. Further research is needed to validate discriminative performance and practical implications of the CCQ in detecting exacerbations in daily care.

[1]  S. Hurd,et al.  Global Strategy for the Diagnosis, Management and Prevention of COPD: 2003 update , 2003, European Respiratory Journal.

[2]  S. Ramsey,et al.  The economic burden of COPD. , 2000, Chest.

[3]  D. Altman,et al.  Statistics Notes: Diagnostic tests 2: predictive values , 1994, BMJ.

[4]  Dirkje S Postma,et al.  Health and Quality of Life Outcomes , 2003 .

[5]  M Britton,et al.  The burden of COPD in the U.K.: results from the Confronting COPD survey. , 2003, Respiratory medicine.

[6]  T. Molen,et al.  Health status measurement in COPD: the minimal clinically important difference of the clinical COPD questionnaire , 2006, Respiratory research.

[7]  J. Lammers,et al.  Effects of telemonitoring in patients with chronic obstructive pulmonary disease. , 2008, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[8]  T. Seemungal,et al.  Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. , 1998, American journal of respiratory and critical care medicine.

[9]  J. Bourbeau,et al.  Underreporting exacerbation of chronic obstructive pulmonary disease in a longitudinal cohort. , 2008, American journal of respiratory and critical care medicine.

[10]  J. Bourbeau,et al.  A Self-Management Education Program Including an Action Plan for Acute COPD Exacerbations , 2009, COPD.

[11]  J. Bourbeau,et al.  Self-management and behaviour modification in COPD . , 2004, Patient education and counseling.

[12]  M. Martínez-García,et al.  Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease , 2005, Thorax.

[13]  J. Bourbeau,et al.  Negative impacts of unreported COPD exacerbations on health-related quality of life at 1 year , 2009, European Respiratory Journal.

[14]  J. Bourbeau,et al.  Impact on patients’ health status following early identification of a COPD exacerbation , 2007, European Respiratory Journal.

[15]  N. Anthonisen,et al.  Lower respiratory illnesses promote FEV(1) decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease: results from the lung health study. , 2001, American journal of respiratory and critical care medicine.

[16]  N. Anthonisen,et al.  Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. , 1987, Annals of internal medicine.

[17]  J. Walters,et al.  Action plans for chronic obstructive pulmonary disease. , 2005, The Cochrane database of systematic reviews.

[18]  R. Rodríguez-Roisín,et al.  Toward a consensus definition for COPD exacerbations. , 2000, Chest.

[19]  T. Seemungal,et al.  Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease. , 1999, The European respiratory journal.

[20]  T. Seemungal,et al.  Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. , 2000, American journal of respiratory and critical care medicine.

[21]  T. Seemungal,et al.  Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. , 2004, American journal of respiratory and critical care medicine.

[22]  J. Lammers,et al.  Action Plan to enhance self-management and early detection of exacerbations in COPD patients; a multicenter RCT , 2009, BMC pulmonary medicine.

[23]  A. Pont,et al.  Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study , 2004, Thorax.

[24]  T. Seemungal,et al.  Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease , 2002, Thorax.

[25]  M. Partridge,et al.  A nurse led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease , 2007, Thorax.

[26]  J. Bourbeau,et al.  Promoting effective self-management programmes to improve COPD , 2009, European Respiratory Journal.

[27]  M. Martínez-García,et al.  with chronic obstructive pulmonary disease Severe acute exacerbations and mortality in patients , 2006 .

[28]  L Goldman,et al.  Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) , 1996, American journal of respiratory and critical care medicine.

[29]  F. Maltais,et al.  Counting, analysing and reporting exacerbations of COPD in randomised controlled trials , 2007, Thorax.

[30]  E. Walters,et al.  Self-management education for patients with chronic obstructive pulmonary disease. , 2007, The Cochrane database of systematic reviews.

[31]  J. Izquierdo,et al.  The burden of COPD in Spain: results from the Confronting COPD survey. , 2003, Respiratory medicine.