Short-Term Impact of the Frequency of COPD Exacerbations on Quality of Life

Background: Chronic Obstructive Pulmonary Disease (COPD) patients in the Simvastatin for the prevention of exacerbations in moderate-to-severe COPD (STATCOPE) and Azithromycin for prevention of exacerbations of COPD (MACRO) trials provide an opportunity prospectively study the short-term effect of Acute Exacerbations of COPD (AECOPD). Research Question: We hypothesized that those patients with frequent exacerbations (>= 2 AECOPDs per patient year) would experience greater short-term decline in quality of life as measured by the St. George's Respiratory Questionnaire (SGRQ.) Study Design and Methods: 1934 COPD patients were randomized in STATCOPE or MACRO. Patients who were randomized to Azithromycin in MACRO or were followed less than 180 days were excluded. 1219 patients were included. Patients were divided into two groups: infrequent exacerbators (< 2 exacerbations per patient year), and frequent exacerbators (>= 2 exacerbations per year.) Data were collected at baseline, measured over time, and compared between groups. Results: Of the patients studied, 871 were in the infrequent exacerbators group. 348 were in the frequent exacerbators group. Frequent exacerbators used more respiratory medications, were more likely to have used oxygen, steroids, or antibiotics in the 12 months preceding study entry, had more obstruction on spirometry, and had more severe symptoms as measured by SGRQ at baseline. Over at least 180 days, symptom scores worsened in frequent exacerbators and improved in infrequent exacerbators. Interpretation: Patients with frequent exacerbations of COPD experienced a short-term slight worsening of severely impaired SGRQ symptoms scores, while patients with infrequent exacerbations experienced improvement while on COPD therapies.