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Commonly used patient-reported outcomes do not improve prediction of COPD exacerbations

Alexandra Strassmann, Anja Frei, Sarah Haile, Gerben ter Riet and Milo A Puhan
Chest 2017;152(6):1179–1187.
doi: 10.1016/j.chest.2017.09.003

Implementing preventive measures for patients with chronic obstructive pulmonary disease (COPD), who are at increased risk of exacerbation, is vital to COPD management. While there are many established predictors of COPD exacerbation, including breathlessness, airflow obstruction, smoking and previous exacerbations, it is unclear how useful patient-reported outcomes (PROs) are in predicting COPD exacerbations. The aim of the multicentre four and a half-year prospective cohort study, reported by Alexandra Strassmann (University of Zurich) and colleagues, was to investigate whether PROs covering various symptoms and limitations of patients with COPD are independent predictors of exacerbations, and to see if they improve on existing prediction models. The International Collaborative Effort on Chronic Obstructive Pulmonary Disease: Exacerbation Risk Index Cohorts study observed 408 patients with COPD, and PROs included the Feeling Thermometer, Chronic Respiratory Disease Questionnaire, Hospital Anxiety and Depression Scale, and LASA Physical Activity Questionnaire. The authors concluded that, while patient-reported breathlessness, fatigue, anxiety and physical activity are statistically and independently associated with COPD exacerbations, they do not improve the long-term prediction of COPD exacerbations to a clinically relevant extent when added to established predictors of exacerbations.

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