Imperial College London
Alternate

Emeritus ProfessorGavinDonaldson

Faculty of Medicine, National Heart & Lung Institute

Emeritus Professor of Respiratory Studies
 
 
 
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Contact

 

+44 (0)20 7594 7859gavin.donaldson

 
 
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Location

 

B141Guy Scadding BuildingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Seemungal:2000,
author = {Seemungal, TA and Donaldson, GC and Bhowmik, A and Jeffries, DJ and Wedzicha, JA},
journal = {Am J Respir Crit Care Med},
pages = {1608--1613},
title = {Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease},
volume = {161},
year = {2000}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Although exacerbations of chronic obstructive pulmonary disease (COPD) are associated with symptomatic and physiological deterioration, little is known of the time course and duration of these changes. We have studied symptoms and lung function changes associated with COPD exacerbations to determine factors affecting recovery from exacerbation. A cohort of 101 patients with moderate to severe COPD (mean FEV(1) 41.9% predicted) were studied over a period of 2.5 yr and regularly followed when stable and during 504 exacerbations. Patients recorded daily morning peak expiratory flow rate (PEFR) and changes in respiratory symptoms on diary cards. A subgroup of 34 patients also recorded daily spirometry. Exacerbations were defined by major symptoms (increased dyspnea, increased sputum purulence, increased sputum volume) and minor symptoms. Before onset of exacerbation there was deterioration in the symptoms of dyspnea, sore throat, cough, and symptoms of a common cold (all p < 0.05), but not lung function. Larger falls in PEFR were associated with symptoms of increased dyspnea (p = 0.014), colds (p = 0.047), or increased wheeze (p = 0.009) at exacerbation. Median recovery times were 6 (interquartile range [IQR] 1 to 14) d for PEFR and 7 (IQR 4 to 14) d for daily total symptom score. Recovery of PEFR to baseline values was complete in only 75.2% of exacerbations at 35 d, whereas in 7.1% of exacerbations at 91 d PEFR recovery had not occurred. In the 404 exacerbations where recovery of PEFR to baseline values was complete at 91 d, increased dyspnea and colds at onset of exacerbation were associated with prolonged recovery times (p < 0.001 in both cases). Symptom changes during exacerbation do not closely reflect those of lung function, but their increase may predict exacerbation, with dyspnea or colds characterizing the more severe. Recovery is incomplete in a significant proportion of COPD exacerbations.
AU  - Seemungal,TA
AU  - Donaldson,GC
AU  - Bhowmik,A
AU  - Jeffries,DJ
AU  - Wedzicha,JA
EP  - 1613
PY  - 2000///
SN  - 1073-449X
SP  - 1608
TI  - Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease
T2  - Am J Respir Crit Care Med
VL  - 161
ER  -
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