Patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) tend to have greater disease severity and increased use of medications than patients with no COPD exacerbations. Although hospitalization for acute exacerbations of COPD may be necessary for getting disease under control, admission for these exacerbations may not be the answer for improving long-term quality of life (QOL), according to research findings published in Respiratory Medicine.

In a study by the COPD Clinical Research Network and the Canadian Institutes of Health Research, researchers compared QOL between patients with COPD who were hospitalized for acute exacerbations and those who were not hospitalized for acute exacerbations and those without exacerbations.

The cohort included 1219 patients with COPD enrolled in 2 trials of medications for acute COPD exacerbations, STATCOPE (for simvastatin; ClinicalTrials.gov Identifier: NCT01061671) and MACRO (for the macrolide azithromycin; ClinicalTrials.gov Identifier: NCT00325897). Study participants had either no COPD exacerbations (n=371; mean age, 63.2±9.1 years), 1 or more outpatient exacerbations but no hospitalization (n=536; mean age, 63.9±8.6 years), or 1 or more hospitalized exacerbations (n=312; mean age, 63.7±8.1 years).


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Within the study cohort, those hospitalized for acute exacerbations were more likely to be Black and to have a lower body mass index than patients who were not hospitalized for exacerbations. Women were more likely to have nonhospitalized exacerbations. Patients with hospitalized exacerbations had longer follow-up duration (581±297 days) than those with nonhospitalized exacerbations (539±273 days) and those without exacerbations (493±268 days; P <.001).

At baseline, use of supplemental oxygen and use of systemic glucocorticoids and antibiotics within the past 12 months was significantly greater among patients hospitalized for COPD exacerbations vs patients without exacerbations and those with nonhospitalized exacerbations (for supplemental oxygen: 64.1% vs 41% and 51.7%, respectively; P <.001; for glucocorticoid/antibiotic use: 92% vs 80.7% vs 86%, respectively; P <.001).

Disease-specific QOL was measured by the St. George’s respiratory questionnaire (SGRQ), while overall health-related QOL was measured by the Short Form-36 quality-of-life survey. These scores did not demonstrate significant changes between groups over time, suggesting that hospitalization did not improve QOL. Only patients with no exacerbations showed a significant increase in QOL.

Factors most predictive of COPD exacerbation hospitalization, according to multivariate analysis, were length of time in the study, baseline forced expiratory volume in 1 second, previous steroid use, prior oxygen use, previous antibiotic use, and prior history of acute exacerbations.

The researchers concluded that although hospitalized patients with COPD “may receive more aggressive and well-rounded treatment compared to those not hospitalized,” this did not translate into improved QOL outcomes. As such, the study suggests that QOL outcomes may be affected more by disease severity at baseline than by the care received.

Reference

Camac ER, Voelker H, Criner GJ; COPD Clinical Research Network and the Canadian Institutes of Health Research. Impact of COPD exacerbations leading to hospitalization on general and disease-specific quality of life. Respir Med. Published online June 29, 2021. doi:10.1016/j.rmed.2021.106526