title: How do COPD patients respond to exacerbations?
abstract: BACKGROUND
  Although timely treatment of COPD exacerbations seems clinically important, nearly half of these exacerbations remain unreported and subsequently untreated. Recent studies have investigated incidence and impact of failure to seek medical treatment during exacerbations. Yet, little is known about type and timing of other self-management actions in periods of symptom deterioration. The current prospective study aims at determining the relative incidence, timing and determinants of three types of patient responses.
  
  
  METHODS
  In a multicentre observational study, 121 patients (age 67 ± 11 years, FEV1pred. 48 ± 19) were followed for 6 weeks by daily diary symptom recording. Three types of action were assessed daily: planning periods of rest, breathing techniques and/or sputum clearing (type-A), increased bronchodilator use (type-B) and contacting a healthcare provider (type-C).
  
  
  RESULTS
  Type-A action was taken in 70.7%, type-B in 62.7% and type C in 17.3% of exacerbations (n = 75). Smokers were less likely to take type-A and B actions. Type-C actions were associated with more severe airflow limitation and increased number of hospital admissions in the last year.
  
  
  CONCLUSIONS
  Our study shows that most patients are willing to take timely self-management actions during exacerbations. Future research is needed to determine whether the low incidence of contacting a healthcare provider is due to a lack of self-management or healthcare accessibility.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. J.C.A.trappenburg@umcutrecht.nl
authors.forename: Jaap C A
authors.initials: JC
authors.lastname: Trappenburg
authors.forename: David
authors.initials: D
authors.lastname: Schaap
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Monninkhof
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.forename: Gerdien H
authors.initials: GH
authors.lastname: de Weert-van Oene
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
mesh_terms: D000368:Aged; D001945:Breathing Exercises; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012146:Rest; D012648:Self Care; D013183:Sputum; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents