Defining COPD exacerbations: impact on estimation of incidence and burden in primary care.
OBJECTIVE
To investigate the impact of definition on the incidence of chronic obstructive pulmonary disease (COPD) exacerbations in primary care.


METHODS
In a one-year prospective, observational study, data from diary cards were used to determine the incidence of symptom- and healthcare-defined exacerbations. One hundred and twenty seven patients completed > or =80% of days in the diary card and were included in the analysis.


RESULTS
Incidence of COPD exacerbation varied according to definition. Mean yearly rates were 2.3 for symptom- and 2.8 for healthcare-defined exacerbations. Although patients with FEV(1) <50% had a higher mean yearly rate of healthcare-defined exacerbations than those with FEV(1) > or =50% (3.2 vs 2.3; p=0.003), patients with less severe disease reported recurrent exacerbations. There was limited agreement between symptom- and healthcare-defined exacerbations.


CONCLUSIONS
Lung function does not appear to be a valid criterion for assigning COPD management directed at patients with recurrent exacerbation.
O'Reilly
John F
JF
University Hospital, Aintree, Liverpool, UK.
Williams
Angela E
AE
Holt
Kay
K
Rice
Leanne
L
D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000503:physiopathology*; D011795:Surveys and Questionnaires