University of Twente Student Theses
Exacerbation-free time to assess the impact of Chronic Obstructive Pulmonary Disease (COPD)
Vries, M.I. de (2021) Exacerbation-free time to assess the impact of Chronic Obstructive Pulmonary Disease (COPD).
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| Full Text Status: | Access to this publication is restricted |
| Embargo date: | 6 July 2023 |
| Abstract: | Background: The course of chronic obstructive pulmonary disease (COPD) is characterised by periods of deterioration of respiratory symptoms, termed exacerbations. In these analyses, data of the COPE-II and COPE-III study were used, which both evaluated the effectiveness of self-management interventions including exacerbation action plans to reduce the number of COPD exacerbation days. The intervention of the COPE-III study was modified to address comorbidities in COPD patients. From the patients’ perspective, it may be appropriate to look at the time they are free from COPD exacerbations to further explore if they derive benefit from using exacerbation action plans. We examined how COPD exacerbation-free time relates to baseline characteristics and health outcomes in COPD patients using exacerbation action plans. Also, whether the relations are different in COPD patients with no or non-severe comorbidities using COPD exacerbation action plans versus COPD patients with comorbidities using COPD and comorbidity-related exacerbation action plans. Methods: Patients with severe comorbidities were excluded in the COPE-II study, while for inclusion in the COPE-III study patients had to be diagnosed with at least one comorbidity (cardiovascular diseases, diabetes mellitus, anxiety, depression). Patients were included in the current analyses if they participated in the self-treatment intervention and had completed at least 75% of their daily symptom diary throughout the 12 months of follow-up. The primary outcome was defined as the number of COPD exacerbation-free days per patient per year and calculated as the inverse of the number of COPD exacerbation days extracted from the daily symptom diaries. Associations of COPD exacerbation-free days with baseline characteristics and health outcomes were analysed. Results: Data were analysed of 147 patients (COPE-II, n=64; COPE-III, n=83). The baseline modified Medical Research Council (mMRC) score, baseline Chronic Respiratory Questionnaire (CRQ) emotional functioning score, gender, and smoking status were associated with COPD exacerbation-free days. Also, COPD exacerbation-free days were related to the mMRC score and CRQ emotional functioning, mastery, dyspnoea, and fatigue scores measured after 12 months of follow-up. The associations of COPD exacerbation-free days with baseline characteristics and health outcomes were largely similar between COPE-II and COPE-III patients. In COPE-II patients, COPD exacerbation-free days were related to feelings of anxiety and depression and in COPE-III patients it was related to depression-related symptoms measured by the Hospital Anxiety and Depression Scale after 12 months of follow-up. Conclusion: COPD exacerbation-free time is related to dyspnoea severity and HRQoL. COPD patients with comorbidities showed stronger associations of dyspnoea severity, emotional functioning, mastery, and depression-related symptoms with COPD exacerbation-free time than COPD patients with no or non-severe comorbidities. |
| Item Type: | Essay (Master) |
| Faculty: | TNW: Science and Technology |
| Programme: | Health Sciences MSc (66851) |
| Link to this item: | https://purl.utwente.nl/essays/87475 |
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