Time course and pattern of COPD exacerbation onset
BackgroundThe natural history and time course of the onset of exacerbation events of chronic obstructive pulmonary disease (COPD) is incompletely understood.MethodsA prospective cohort of 212 patients with COPD was monitored using daily symptom diaries for a median of 2.8 years to characterise the t...
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| Veröffentlicht in: | Thorax 2012-03, Vol.67 (3), p.238-243 |
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| creator | Aaron, Shawn D Donaldson, Gavin C Whitmore, George A Hurst, John R Ramsay, Tim Wedzicha, Jadwiga A |
| description | BackgroundThe natural history and time course of the onset of exacerbation events of chronic obstructive pulmonary disease (COPD) is incompletely understood.MethodsA prospective cohort of 212 patients with COPD was monitored using daily symptom diaries for a median of 2.8 years to characterise the time course of COPD exacerbation onset. Decision rules based on weighted self-reported symptoms were used to define opening and closing of exacerbation events. Event time intervals were analysed and logistic regression was used to determine the effects of patient covariates on exacerbation events.ResultsPatients recorded 4439 episodes of worsening respiratory symptoms from baseline; 2444 (55%) events resolved spontaneously and 1995 (45%) resulted in a COPD exacerbation. In 1115 of the 1995 COPD exacerbations (56%) the onset was sudden and the exacerbation threshold was crossed on the same day symptoms began. In contrast, 44% of exacerbations were characterised by gradual onset of symptoms (median duration from symptom onset to exacerbation 4 days). Patients who experienced sudden onset exacerbations had greater mean daily symptom scores (7.86 vs 6.55 points, p |
| doi_str_mv | 10.1136/thoraxjnl-2011-200768 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_922501692</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4027103741</sourcerecordid><originalsourceid>FETCH-LOGICAL-b558t-cbe6ed64e040d6680a63b8a5a55cc07ae6c48906d03863badb4f97af2a80e4a13</originalsourceid><addsrcrecordid>eNqNkVtP3DAQha0KVJbLT2gVCVU8BcZOfMkj3V4AIeABeLUmzkTNNpfFzkrLv8erbLcST7zY1pxvRmeOGfvC4ZzzTF2MfwaP60XfpgI4jwdoZT6xGc-VSTNRqD02A8ghVZlWB-wwhAUAGM71Z3YgxOZpihkTj01HiRtWPlCCfZUscRzJ98lQJ_P7hx8JrdGRL3FshljsA43HbL_GNtDJ9j5iT79-Ps6v0tv739fzy9u0lNKMqStJUaVyiiYqpQygykqDEqV0DjSScrkpQFWQmahgVeZ1obEWaIBy5NkRO5vmLv3wsqIw2q4JjtoWexpWwRZCSOCqEJE8fUcu4kJ9NGe5jntyoQuIlJwo54cQPNV26ZsO_avlYDeZ2l2mdpOpnTKNfV-301dlR9Wu61-IEfi2BTA4bGuPvWvCf04aHX9FRy6duCaMtN7p6P_aqGpp757nlht4zoobbb9HHia-7BYf9PoGQD-eZQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1781812790</pqid></control><display><type>article</type><title>Time course and pattern of COPD exacerbation onset</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><source>Alma/SFX Local Collection</source><creator>Aaron, Shawn D ; Donaldson, Gavin C ; Whitmore, George A ; Hurst, John R ; Ramsay, Tim ; Wedzicha, Jadwiga A</creator><creatorcontrib>Aaron, Shawn D ; Donaldson, Gavin C ; Whitmore, George A ; Hurst, John R ; Ramsay, Tim ; Wedzicha, Jadwiga A</creatorcontrib><description>BackgroundThe natural history and time course of the onset of exacerbation events of chronic obstructive pulmonary disease (COPD) is incompletely understood.MethodsA prospective cohort of 212 patients with COPD was monitored using daily symptom diaries for a median of 2.8 years to characterise the time course of COPD exacerbation onset. Decision rules based on weighted self-reported symptoms were used to define opening and closing of exacerbation events. Event time intervals were analysed and logistic regression was used to determine the effects of patient covariates on exacerbation events.ResultsPatients recorded 4439 episodes of worsening respiratory symptoms from baseline; 2444 (55%) events resolved spontaneously and 1995 (45%) resulted in a COPD exacerbation. In 1115 of the 1995 COPD exacerbations (56%) the onset was sudden and the exacerbation threshold was crossed on the same day symptoms began. In contrast, 44% of exacerbations were characterised by gradual onset of symptoms (median duration from symptom onset to exacerbation 4 days). Patients who experienced sudden onset exacerbations had greater mean daily symptom scores (7.86 vs 6.55 points, p<0.001), greater peak symptom scores (10.7 vs 10.2 points, p=0.003), earlier peak symptoms (4.5 vs 8.0 days, p<0.001) and shorter median recovery times back to baseline health status (11 vs 13 days, p<0.001). Multivariable analysis showed that gradual onset exacerbations were statistically associated with a longer duration of exacerbation recovery (OR 1.28, 95% CI 1.06 to 1.54, p=0.010).ConclusionsCOPD exacerbations exhibit two distinct patterns—sudden and gradual onset. Sudden onset exacerbations are associated with increased respiratory symptoms but shorter exacerbation recovery times.</description><identifier>ISSN: 0040-6376</identifier><identifier>EISSN: 1468-3296</identifier><identifier>DOI: 10.1136/thoraxjnl-2011-200768</identifier><identifier>PMID: 22008189</identifier><identifier>CODEN: THORA7</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Thoracic Society</publisher><subject>Acute Disease ; Aged ; Anti-Bacterial Agents - therapeutic use ; Biological and medical sciences ; bronchiectasis ; Cardiology. Vascular system ; Chronic obstructive pulmonary disease ; Chronic obstructive pulmonary disease, asthma ; COPD epidemiology ; COPD exacerbations ; COPD mechanisms ; COPD pathology ; COPD pharmacology ; cystic fibrosis ; Diaries ; diary data ; Disease Progression ; event history analysis ; exacerbation ; Female ; Forced Expiratory Volume - physiology ; Glucocorticoids - therapeutic use ; health process ; Humans ; Infections ; logistic regression ; lung physiology ; Male ; Medical sciences ; medication ; Middle Aged ; Patients ; Pneumology ; Prognosis ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive - complications ; Pulmonary Disease, Chronic Obstructive - drug therapy ; Pulmonary Disease, Chronic Obstructive - physiopathology ; Respiration Disorders - etiology ; Respiration Disorders - physiopathology ; Respiratory Tract Infections - complications ; Respiratory Tract Infections - drug therapy ; Risk Factors ; score function ; symptoms ; Time Factors ; Viral infections ; Vital Capacity - physiology</subject><ispartof>Thorax, 2012-03, Vol.67 (3), p.238-243</ispartof><rights>2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright: 2012 (c) 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b558t-cbe6ed64e040d6680a63b8a5a55cc07ae6c48906d03863badb4f97af2a80e4a13</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://thorax.bmj.com/content/67/3/238.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://thorax.bmj.com/content/67/3/238.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3194,23570,27923,27924,77371,77402</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25871467$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22008189$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aaron, Shawn D</creatorcontrib><creatorcontrib>Donaldson, Gavin C</creatorcontrib><creatorcontrib>Whitmore, George A</creatorcontrib><creatorcontrib>Hurst, John R</creatorcontrib><creatorcontrib>Ramsay, Tim</creatorcontrib><creatorcontrib>Wedzicha, Jadwiga A</creatorcontrib><title>Time course and pattern of COPD exacerbation onset</title><title>Thorax</title><addtitle>Thorax</addtitle><description>BackgroundThe natural history and time course of the onset of exacerbation events of chronic obstructive pulmonary disease (COPD) is incompletely understood.MethodsA prospective cohort of 212 patients with COPD was monitored using daily symptom diaries for a median of 2.8 years to characterise the time course of COPD exacerbation onset. Decision rules based on weighted self-reported symptoms were used to define opening and closing of exacerbation events. Event time intervals were analysed and logistic regression was used to determine the effects of patient covariates on exacerbation events.ResultsPatients recorded 4439 episodes of worsening respiratory symptoms from baseline; 2444 (55%) events resolved spontaneously and 1995 (45%) resulted in a COPD exacerbation. In 1115 of the 1995 COPD exacerbations (56%) the onset was sudden and the exacerbation threshold was crossed on the same day symptoms began. In contrast, 44% of exacerbations were characterised by gradual onset of symptoms (median duration from symptom onset to exacerbation 4 days). Patients who experienced sudden onset exacerbations had greater mean daily symptom scores (7.86 vs 6.55 points, p<0.001), greater peak symptom scores (10.7 vs 10.2 points, p=0.003), earlier peak symptoms (4.5 vs 8.0 days, p<0.001) and shorter median recovery times back to baseline health status (11 vs 13 days, p<0.001). Multivariable analysis showed that gradual onset exacerbations were statistically associated with a longer duration of exacerbation recovery (OR 1.28, 95% CI 1.06 to 1.54, p=0.010).ConclusionsCOPD exacerbations exhibit two distinct patterns—sudden and gradual onset. Sudden onset exacerbations are associated with increased respiratory symptoms but shorter exacerbation recovery times.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>bronchiectasis</subject><subject>Cardiology. Vascular system</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>COPD epidemiology</subject><subject>COPD exacerbations</subject><subject>COPD mechanisms</subject><subject>COPD pathology</subject><subject>COPD pharmacology</subject><subject>cystic fibrosis</subject><subject>Diaries</subject><subject>diary data</subject><subject>Disease Progression</subject><subject>event history analysis</subject><subject>exacerbation</subject><subject>Female</subject><subject>Forced Expiratory Volume - physiology</subject><subject>Glucocorticoids - therapeutic use</subject><subject>health process</subject><subject>Humans</subject><subject>Infections</subject><subject>logistic regression</subject><subject>lung physiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>medication</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Pneumology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Pulmonary Disease, Chronic Obstructive - drug therapy</subject><subject>Pulmonary Disease, Chronic Obstructive - physiopathology</subject><subject>Respiration Disorders - etiology</subject><subject>Respiration Disorders - physiopathology</subject><subject>Respiratory Tract Infections - complications</subject><subject>Respiratory Tract Infections - drug therapy</subject><subject>Risk Factors</subject><subject>score function</subject><subject>symptoms</subject><subject>Time Factors</subject><subject>Viral infections</subject><subject>Vital Capacity - physiology</subject><issn>0040-6376</issn><issn>1468-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkVtP3DAQha0KVJbLT2gVCVU8BcZOfMkj3V4AIeABeLUmzkTNNpfFzkrLv8erbLcST7zY1pxvRmeOGfvC4ZzzTF2MfwaP60XfpgI4jwdoZT6xGc-VSTNRqD02A8ghVZlWB-wwhAUAGM71Z3YgxOZpihkTj01HiRtWPlCCfZUscRzJ98lQJ_P7hx8JrdGRL3FshljsA43HbL_GNtDJ9j5iT79-Ps6v0tv739fzy9u0lNKMqStJUaVyiiYqpQygykqDEqV0DjSScrkpQFWQmahgVeZ1obEWaIBy5NkRO5vmLv3wsqIw2q4JjtoWexpWwRZCSOCqEJE8fUcu4kJ9NGe5jntyoQuIlJwo54cQPNV26ZsO_avlYDeZ2l2mdpOpnTKNfV-301dlR9Wu61-IEfi2BTA4bGuPvWvCf04aHX9FRy6duCaMtN7p6P_aqGpp757nlht4zoobbb9HHia-7BYf9PoGQD-eZQ</recordid><startdate>20120301</startdate><enddate>20120301</enddate><creator>Aaron, Shawn D</creator><creator>Donaldson, Gavin C</creator><creator>Whitmore, George A</creator><creator>Hurst, John R</creator><creator>Ramsay, Tim</creator><creator>Wedzicha, Jadwiga A</creator><general>BMJ Publishing Group Ltd and British Thoracic Society</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20120301</creationdate><title>Time course and pattern of COPD exacerbation onset</title><author>Aaron, Shawn D ; Donaldson, Gavin C ; Whitmore, George A ; Hurst, John R ; Ramsay, Tim ; Wedzicha, Jadwiga A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b558t-cbe6ed64e040d6680a63b8a5a55cc07ae6c48906d03863badb4f97af2a80e4a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>bronchiectasis</topic><topic>Cardiology. Vascular system</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>COPD epidemiology</topic><topic>COPD exacerbations</topic><topic>COPD mechanisms</topic><topic>COPD pathology</topic><topic>COPD pharmacology</topic><topic>cystic fibrosis</topic><topic>Diaries</topic><topic>diary data</topic><topic>Disease Progression</topic><topic>event history analysis</topic><topic>exacerbation</topic><topic>Female</topic><topic>Forced Expiratory Volume - physiology</topic><topic>Glucocorticoids - therapeutic use</topic><topic>health process</topic><topic>Humans</topic><topic>Infections</topic><topic>logistic regression</topic><topic>lung physiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>medication</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Pneumology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Pulmonary Disease, Chronic Obstructive - complications</topic><topic>Pulmonary Disease, Chronic Obstructive - drug therapy</topic><topic>Pulmonary Disease, Chronic Obstructive - physiopathology</topic><topic>Respiration Disorders - etiology</topic><topic>Respiration Disorders - physiopathology</topic><topic>Respiratory Tract Infections - complications</topic><topic>Respiratory Tract Infections - drug therapy</topic><topic>Risk Factors</topic><topic>score function</topic><topic>symptoms</topic><topic>Time Factors</topic><topic>Viral infections</topic><topic>Vital Capacity - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aaron, Shawn D</creatorcontrib><creatorcontrib>Donaldson, Gavin C</creatorcontrib><creatorcontrib>Whitmore, George A</creatorcontrib><creatorcontrib>Hurst, John R</creatorcontrib><creatorcontrib>Ramsay, Tim</creatorcontrib><creatorcontrib>Wedzicha, Jadwiga A</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Thorax</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aaron, Shawn D</au><au>Donaldson, Gavin C</au><au>Whitmore, George A</au><au>Hurst, John R</au><au>Ramsay, Tim</au><au>Wedzicha, Jadwiga A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Time course and pattern of COPD exacerbation onset</atitle><jtitle>Thorax</jtitle><addtitle>Thorax</addtitle><date>2012-03-01</date><risdate>2012</risdate><volume>67</volume><issue>3</issue><spage>238</spage><epage>243</epage><pages>238-243</pages><issn>0040-6376</issn><eissn>1468-3296</eissn><coden>THORA7</coden><abstract>BackgroundThe natural history and time course of the onset of exacerbation events of chronic obstructive pulmonary disease (COPD) is incompletely understood.MethodsA prospective cohort of 212 patients with COPD was monitored using daily symptom diaries for a median of 2.8 years to characterise the time course of COPD exacerbation onset. Decision rules based on weighted self-reported symptoms were used to define opening and closing of exacerbation events. Event time intervals were analysed and logistic regression was used to determine the effects of patient covariates on exacerbation events.ResultsPatients recorded 4439 episodes of worsening respiratory symptoms from baseline; 2444 (55%) events resolved spontaneously and 1995 (45%) resulted in a COPD exacerbation. In 1115 of the 1995 COPD exacerbations (56%) the onset was sudden and the exacerbation threshold was crossed on the same day symptoms began. In contrast, 44% of exacerbations were characterised by gradual onset of symptoms (median duration from symptom onset to exacerbation 4 days). Patients who experienced sudden onset exacerbations had greater mean daily symptom scores (7.86 vs 6.55 points, p<0.001), greater peak symptom scores (10.7 vs 10.2 points, p=0.003), earlier peak symptoms (4.5 vs 8.0 days, p<0.001) and shorter median recovery times back to baseline health status (11 vs 13 days, p<0.001). Multivariable analysis showed that gradual onset exacerbations were statistically associated with a longer duration of exacerbation recovery (OR 1.28, 95% CI 1.06 to 1.54, p=0.010).ConclusionsCOPD exacerbations exhibit two distinct patterns—sudden and gradual onset. Sudden onset exacerbations are associated with increased respiratory symptoms but shorter exacerbation recovery times.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Thoracic Society</pub><pmid>22008189</pmid><doi>10.1136/thoraxjnl-2011-200768</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Aged Anti-Bacterial Agents - therapeutic use Biological and medical sciences bronchiectasis Cardiology. Vascular system Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease, asthma COPD epidemiology COPD exacerbations COPD mechanisms COPD pathology COPD pharmacology cystic fibrosis Diaries diary data Disease Progression event history analysis exacerbation Female Forced Expiratory Volume - physiology Glucocorticoids - therapeutic use health process Humans Infections logistic regression lung physiology Male Medical sciences medication Middle Aged Patients Pneumology Prognosis Prospective Studies Pulmonary Disease, Chronic Obstructive - complications Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - physiopathology Respiration Disorders - etiology Respiration Disorders - physiopathology Respiratory Tract Infections - complications Respiratory Tract Infections - drug therapy Risk Factors score function symptoms Time Factors Viral infections Vital Capacity - physiology |
| title | Time course and pattern of COPD exacerbation onset |
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