BACKGROUND: The impact of acute exacerbations of chronic bronchitis (AECB), a common consequence of chronic obstructive pulmonary disease (COPD), is extensive, with symptoms ranging from mild to life threatening. Health-related quality of life (HRQL) is impaired in patients with COPD, but little is known about the direct effect of exacerbations on HRQL. METHODS: MEDLINE and EMBASE literature searches were conducted; reference lists of identified articles were reviewed. RESULTS: Eighteen studies reporting the impact on HRQL of acute exacerbations were identified. Study design and patient population varied. Six studies evaluated HRQL once; only four studies used both generic and disease-specific HRQL measures. Cross-sectional studies reported HRQL decrements during exacerbations and suggested that HRQL is a good predictor of health care resource utilization. Pharmacological treatment led to within-group improvements following AECBs. Non-pharmacological intervention studies were small and inconclusive. Longitudinal studies, assessing pharmacological and non-pharmacological interventions, found that HRQL improved from exacerbation to recovery, with responsiveness depending on sensitivity of the measure. Frequency of exacerbations was a significant predictor of HRQL. CONCLUSIONS: Exacerbations lead to substantial reductions in HRQL, both in physical as well as other domains. Further research should assess the impact of specific treatment regimens and the timeline for the recovery process.
BACKGROUND: The impact of acute exacerbations of chronic bronchitis (AECB), a common consequence of chronic obstructive pulmonary disease (COPD), is extensive, with symptoms ranging from mild to life threatening. Health-related quality of life (HRQL) is impaired in patients with COPD, but little is known about the direct effect of exacerbations on HRQL. METHODS: MEDLINE and EMBASE literature searches were conducted; reference lists of identified articles were reviewed. RESULTS: Eighteen studies reporting the impact on HRQL of acute exacerbations were identified. Study design and patient population varied. Six studies evaluated HRQL once; only four studies used both generic and disease-specific HRQL measures. Cross-sectional studies reported HRQL decrements during exacerbations and suggested that HRQL is a good predictor of health care resource utilization. Pharmacological treatment led to within-group improvements following AECBs. Non-pharmacological intervention studies were small and inconclusive. Longitudinal studies, assessing pharmacological and non-pharmacological interventions, found that HRQL improved from exacerbation to recovery, with responsiveness depending on sensitivity of the measure. Frequency of exacerbations was a significant predictor of HRQL. CONCLUSIONS: Exacerbations lead to substantial reductions in HRQL, both in physical as well as other domains. Further research should assess the impact of specific treatment regimens and the timeline for the recovery process.
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