Two studies presented at the American Thoracic Society 2018 International Conference find that exacerbations must be addressed in order to help improve outcomes for patients with chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) patients may face various exacerbations that may affect their daily lives. COPD studies usually define exacerbations based on healthcare resource utilization (HCRU). Another way to measure exacerbations is by recording symptoms in a daily diary, so that monitoring prevents symptoms from worsening.
The AERIS study, presented at the American Thoracic Society (ATS) 2018 International Conference, evaluated patients with COPD with a history of exacerbations.1 The patients completed morning and evening diaries and if a symptomatic change was recorded in the morning, the patients were asked to attend the clinic for evaluation/treatment. Furthermore, the study considered HCRU exacerbations to be mild if they were self-managed through antibiotics or severe if the patient was hospitalized.
The EXAcerbations of Chronic Pulmonary Disease Tool (EXACT) was used to score the symptoms and to determine if they were worsening throughout the day.
A total of 578 HCRU exacerbations and 197 symptom-defined (SD) events were detected among the 127 patients in a 24-month period. Of the HCRU exacerbations, 54% were diary triggered, 46% were spontaneous, and 23.5% of the exacerbations met the threshold for a SD event with no significant difference between spontaneous and triggered.
“Most HCRU exacerbations didn’t meet the threshold required to be identified as an SD event," the authors concluded. "Monitoring of, and acting on, changes in daily morning symptoms may have prevented more severe exacerbations from developing. Further study is needed to document the severity of symptomatic change with HCRU-exacerbations.”
Another study, also presented at the ATS meeting, investigated a specific type of exacerbation for patients with COPD: allergen exposure. The analysis aimed to understand how allergen sensitization with and without exposure to indoor allergens affects the outcomes of patients with COPD.
The study included 403 individuals with COPD and they were analyzed for 10 common allergens. Allergen sensitization and allergen exposure data was collected using settled dust collection for mouse, cat, cockroach, and dust mite allergens.
The results suggested sensitization was associated with less emphysema and gas trapping. Also, sensitization was associated with higher risk for frequent wheezing but no other increased respiratory morbidity. Of the cohort, 18% were atopic with 100% having exposure to at least 2 allergens and 10% had positive sensitization with exposure to the respective allergen.
“Sensitization with exposure to allergens may carry higher risk for healthcare utilization,” concluded the authors. “This work has important implications for possible environmental strategies to improve outcomes in atopic patients with COPD.”
Overall, both studies find that exacerbations must be addressed in order to help improve outcomes for patients COPD.
1. Sung R, Collier S, Devaster J, et al. Concordance between health care utilization and symptom-defined exacerbations in patients with COPD: results from the acute exacerbation and respiratory infections (AERIS) study. Presented at the American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, California. Abstract A2770.
2. Putcha N, Fawzy A, Matsui E, et al. Allergen sensitization and exposure is associated with exacerbations in COPD. Presented at the American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, California. Abstract A2750.