RT Journal Article SR Electronic T1 Longitudinal changes in the nature, severity and frequency of COPD exacerbations JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 931 OP 936 DO 10.1183/09031936.03.00038303 VO 22 IS 6 A1 Donaldson, G.C. A1 Seemungal, T.A.R. A1 Patel, I.S. A1 Lloyd-Owen, S.J. A1 Wilkinson, T.M.A. A1 Wedzicha, J.A. YR 2003 UL https://publications.ersnet.org//content/22/6/931.abstract AB Exacerbations are an important feature and outcome measure in chronic obstructive pulmonary disease (COPD), but little is known about changes in their severity, recovery, symptom composition or frequency over time. In this study 132 patients (91 male; median age 68.4 yrs and median forced expiratory volume in one second (FEV1) 38.4% predicted) recorded daily symptoms and morning peak expiratory flow. Patients were monitored for a median of 918 days and 1,111 exacerbations were identified. Patients with severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) category III, n=38) had an annual exacerbation frequency of 3.43·yr−1, 0.75·yr−1 higher than those with moderate COPD (GOLD II, n=94). Exacerbation frequency did not change significantly during the study. At exacerbation onset, symptom count increased to 2.23, relative to a baseline of 0.36 set 8–14 days previously, and this increase rose by 0.05·yr−1. Recovery to baseline levels in symptoms and FEV1 took longer (0.32 and 0.55 days·yr−1). Sputum purulence at exacerbation became more prevalent over time by 4.1%·yr−1 from an initial value of 17%. The results of this study suggest that over time, individual patients have more symptoms during exacerbations, with an increased chance of sputum purulence and longer recovery times. This study was supported by the British Lung Foundation and GlaxoSmithKline.