Background: Acute exacerbations of chronic obstructive pulmonary disease(COPD) are defined by progression of respiratory symptoms warranting escalation of therapies including systemic glucocorticoids. The duration of systemic glucocorticoids therapy is unclear, recent studies have shown 5 days is as efficacious as 14 leading to revision of consensus guidelines adopting this shorter course. We sought to determine the temporal response of daily respiratory symptoms during the pefi-exacerbation period when patients are prescribed 10 days of glucocorticoids by using an electronic daily diary.
Methods: 170 consecutive patients were enrolled over 18 months into a COPD telemedicine based disease management program. Patients accounted for a total of 408 outpatient COPD exacerbations all of which were prescribed 10 days of oral glucocorticoids. Patients had retrospective review of their daily symptoms as well as peak expiratory flow rates and thoracic computerized tomography scans reviewed by four independent chest physicians. Dyspnea (modified Borg), sputum quantity, color and consistency, peak flow rates and upper airways symptoms of sneezing, sore throat, cough and wheeze were recorded.
Results: 170 patients with mean age of 66±7.19 yrs. and mean FEVI 40% ±17 of predicted were monitored for 18 months. Annual per person exacerbation rate was 2.39 and exacerbations were managed either exclusively with glucocorticoids (58%) or combination glucocorticoids and antibiotics (42%). 63% (n=258) of exacerbations resolved, defined as return to baseline symptoms, within 10 days of starting glucocorticoids, and 150 patients (37% of total prescribed glucocorticoids) returned to baseline score within 5 days.
Recovery time was independent of a patient’s baseline spirometry, six-minute walk distance and demographic profile. In patients experiencing multiple exacerbations (n=101, 59%) recovery time varied between individual exacerbations, however 65% displayed similar recovery outcomes. Exacerbation recovery was independent of annual seasonal variations. Exacerbation frequency during the study period was independent of spirometry, baseline demographics and CT findings including % emphysema, and the presence of bronchiectasis or bronchial wall thickening.
Conclusion: A patient’s return to their pre-exacerbation respiratory baseline occurs at variable rates despite uniform therapies, and is independent of baseline spirometry and a patient’s demographic profile. Additionally, the majority of our cohort was still symptomatic after 5 days of systemic glucocorticoids contrary to new consensus therapy recommendations. Development of better tools to specifically phenotype COPD patients to determine the implementation and duration of individual based treatments such as glucocorticoids for the onset of a COPD exacerbation are warranted.