Day-to-day measurement of patient-reported outcomes in exacerbations of chronic obstructive pulmonary disease

Jan Willem H Kocks,^1,2 Jan Willem K van den Berg,³ Huib AM Kerstjens,^2,4 Steven M Uil,³ Judith M Vonk,^2,5 Ynze P de Jong,³ Ioanna G Tsiligianni,^1,2 Thys van der Molen<sup>1,2

1</sup>Department of General Practice, ²Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, ³Department of Pulmonary Diseases, Isala Klinieken, Zwolle, ⁴Department of Pulmonary Diseases and Tuberculosis, ⁵Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major burden to patients and to society. Little is known about the possible role of day-to-day patient-reported outcomes during an exacerbation. This study aims to describe the day-to-day course of patient-reported health status during exacerbations of COPD and to assess its value in predicting clinical outcomes.
Methods: Data from two randomized controlled COPD exacerbation trials (n = 210 and n = 45 patients) were used to describe both the feasibility of daily collection of and the day-to-day course of patient-reported outcomes during outpatient treatment or admission to hospital. In addition to clinical parameters, the BORG dyspnea score, the Clinical COPD Questionnaire (CCQ), and the St George's Respiratory Questionnaire were used in Cox regression models to predict treatment failure, time to next exacerbation, and mortality in the hospital study.
Results: All patient-reported outcomes showed a distinct pattern of improvement. In the multivariate models, absence of improvement in CCQ symptom score and impaired lung function were independent predictors of treatment failure. Health status and gender predicted time to next exacerbation. Five-year mortality was predicted by age, forced expiratory flow in one second % predicted, smoking status, and CCQ score. In outpatient management of exacerbations, health status was found to be less impaired than in hospitalized patients, while the rate and pattern of recovery was remarkably similar.
Conclusion: Daily health status measurements were found to predict treatment failure, which could help decision-making for patients hospitalized due to an exacerbation of COPD.

Keywords: health status, Clinical COPD Questionnaire, hospital, admission, prediction