Abstract
Uncertainty exists over the ability of the Exacerbations of Chronic Obstructive Pulmonary Disease Tool (EXACT) patient-reported outcome diary to quantify exacerbation severity and frequency. To clarify this we investigated the ability of the EXACT to assess severity of exacerbations and examined the relationship between exacerbations diagnosed using London COPD cohort diary cards, physician review and symptom-defined events using the EXACT.
58 patients enrolled in the London COPD cohort prospectively completed the EXACT during 128 cohort diary card-defined exacerbations between January 2010 and April 2012.
Mean EXACT scores increased from 42.6 (SD 8.6) at baseline to 48.0 (8.6) at exacerbation onset (p<0.001), and rose further to a maximum score of 54.1 (8.9). Maximum EXACT scores were significantly higher in treated than untreated events. Time taken for EXACT scores to return to baseline was significantly related to symptom recovery time as judged by London COPD cohort diary cards, and to PEFR recovery. Approximately 50% of both diary card-defined and HCU exacerbations crossed the EXACT event threshold.
However, only 27.9% of diary-card defined and 34.6% of HCU exacerbations fully met the criteria for an EXACT event. Patients exhibited smaller rises in EXACT score at exacerbation as baseline disease severity increased.
The EXACT is an effective method of evaluating COPD exacerbation severity. However, concerns remain about the ability of the EXACT to accurately detect exacerbations.
- ERS