Chest
Volume 121, Issue 3, March 2002, Pages 688-696
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Clinical Investigations
Measurement of Short-term Changes in Dyspnea and Disease-Specific Quality of Life Following an Acute COPD Exacerbation

https://doi.org/10.1378/chest.121.3.688Get rights and content

Study objective

To determine whether currently available measurement tools can be used to obtain valid measurements of short-term changes in dyspnea and disease-specific quality of life (QOL) in outpatients with an acute COPD exacerbation.

Methods

Sixty-six patients with an acute COPD exacerbation who presented to the emergency department completed the chronic respiratory disease index questionnaire (CRQ) and the baseline dyspnea index (BDI) and were discharged home receiving 10 days of medical therapy. Reassessment with the CRQ and the transitional dyspnea index (TDI) occurred within 48 h of relapse (defined as an urgent hospital revisit within 10 days because of worsening respiratory symptoms), or 10 days later if relapse did not occur.

Results

Patients who did not relapse (n = 49) showed moderate-to-large improvements in disease-specific QOL across all four CRQ domains (improvements in each domain of 1.4 to 1.9 U; p < 0.001 for all domains) and large positive changes in the TDI (total TDI score, + 5.02 ± 0.55 U; p = 0.0001). In contrast, patients who had a relapse (n = 17) did not have improved CRQ or TDI scores (mean negative change in three of four CRQ domains, total TDI score − 3.06 ± 1.14 U; p = 0.02). Changes in the CRQ dyspnea score and TDI correlated with each other (r = 0.78; p = 0.0001) and with changes in FEV1 (CRQ, r = 0.48 and p = 0.0001; TDI, r = 0.46 and p = 0.0002). Ten control patients with stable COPD showed no changes in the CRQ or TDI over 10 days.

Conclusion

The CRQ and BDI/TDI can be used to obtain valid, responsive measures of acute changes in QOL and dyspnea associated with a COPD exacerbation. The direction and magnitude of change in these scores was highly correlated with clinical outcome and with other health measures. Most outpatients treated for a COPD exacerbation experience significant short-term improvements in QOL and dyspnea, with the exception of patients who have a clinical relapse of symptoms.

Section snippets

Patients

Patients with an acute COPD exacerbation (characterized by increased chronic baseline dyspnea, increased sputum volume, and/or increased sputum purulence)15 were recruited to the study from four Eastern Ontario emergency departments (EDs) during the winter months from January 1998 to March 2000. Inclusion criteria for entry included: (1) a previous diagnosis of COPD, (2) FEV1 ≤ 70% of predicted and an FEV1/FVC ratio ≤ 70% in the ED, (3) evidence of chronic airflow obstruction (obtained at a

Results

Seventy patients with acute COPD exacerbation were recruited into the study on initial presentation to the ED. Of these 70 patients, 66 patients completed the initial and day-10 follow-up assessments. Four patients did not complete the study: one patient dropped out of the study on day 3, one patient was unavailable for follow-up until day 17, and two patients returned for reassessment on day 10 but refused to complete the day-10 CRQ and TDI.

Baseline characteristics of the 70 enrolled patients

Discussion

This study has been successful in documenting short-term changes in disease-specific QOL and dyspnea that occur immediately following acute COPD exacerbation. Our study demonstrates that most patients experience significant improvements in QOL and dyspnea following 10 days of medical therapy for an acute COPD exacerbation. However, this study has also shown that there exists a subset of outpatients whose dyspnea and QOL clearly do not improve, and that these are the patients who seek further

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Supported by grant 13098 from the Ontario Emergency Health Services Research Fund and by grant MCT-41545 from the Canadian Institutes of Health Research.

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