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Longitudinal change in quality of life following hospitalisation for acute exacerbations of COPD.

Steer J, Gibson GJ, Bourke SC - BMJ Open Respir Res (2015)

Bottom Line: Undue nihilism might lead to denial of potentially life-saving therapy, while undue optimism might prolong suffering when alternative palliation would be more appropriate.Both groups showed clinically important improvements in respiratory symptoms and an individual's sense of control over their condition, despite the tendency for functional status to decline.Certain quality of life domains (ie, symptoms and mastery) improved significantly.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine , North Tyneside General Hospital , North Shields, Tyne and Wear , UK.

ABSTRACT

Background: Current guidelines for management of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (COPD) recommend that clinical decisions, including escalation to assisted ventilation, be informed by an estimate of the patients' likely postdischarge quality of life. There is little evidence to inform predictions of outcome in terms of quality of life, psychological well-being and functional status. Undue nihilism might lead to denial of potentially life-saving therapy, while undue optimism might prolong suffering when alternative palliation would be more appropriate. This study aimed to detail longitudinal changes in quality of life following hospitalisation for acute exacerbations of COPD.

Methods: We prospectively recruited two cohorts (exacerbations requiring assisted ventilation during admission and exacerbations not ventilated). Admission clinical data, and mortality and readmission details were collected. Quality of life, psychological well-being and functional status were formally assessed over the subsequent 12 months. Time-adjusted mean change in quality of life was examined.

Results: 183 patients (82 ventilated; 101 not ventilated) were recruited. On average, overall quality of life improved by a clinically important amount in those not ventilated and did not decline in ventilated patients. Both groups showed clinically important improvements in respiratory symptoms and an individual's sense of control over their condition, despite the tendency for functional status to decline.

Conclusions: On average, postdischarge quality of life improved in non-ventilated and did not decline in ventilated patients. Certain quality of life domains (ie, symptoms and mastery) improved significantly. Better understanding of longitudinal change in postdischarge quality of life should help to inform decision-making.

No MeSH data available.


Related in: MedlinePlus

Twelve-month survival of ventilated and non-ventilated patients.
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BMJRESP2014000069F1: Twelve-month survival of ventilated and non-ventilated patients.

Mentions: Most patients (n=130, 71%) were rehospitalised during the 12-month follow-up period (median (IQR) readmissions=1 (0–3), range 0–15). In total, 157 (86%) patients reported at least one episode of AECOPD during follow-up (median (IQR) AECOPD=3 (1–6), range 0–15). Ventilated patients were more likely to be readmitted and spent more days in hospital during the 12 months following discharge (table 3). Thirty-five (19%) patients died during follow-up: mortality was non-significantly higher in ventilated compared with non-ventilated patients (23.2% vs 15.8%; log-rank p=0.20; figure 1).


Longitudinal change in quality of life following hospitalisation for acute exacerbations of COPD.

Steer J, Gibson GJ, Bourke SC - BMJ Open Respir Res (2015)

Twelve-month survival of ventilated and non-ventilated patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4305076&req=5

BMJRESP2014000069F1: Twelve-month survival of ventilated and non-ventilated patients.
Mentions: Most patients (n=130, 71%) were rehospitalised during the 12-month follow-up period (median (IQR) readmissions=1 (0–3), range 0–15). In total, 157 (86%) patients reported at least one episode of AECOPD during follow-up (median (IQR) AECOPD=3 (1–6), range 0–15). Ventilated patients were more likely to be readmitted and spent more days in hospital during the 12 months following discharge (table 3). Thirty-five (19%) patients died during follow-up: mortality was non-significantly higher in ventilated compared with non-ventilated patients (23.2% vs 15.8%; log-rank p=0.20; figure 1).

Bottom Line: Undue nihilism might lead to denial of potentially life-saving therapy, while undue optimism might prolong suffering when alternative palliation would be more appropriate.Both groups showed clinically important improvements in respiratory symptoms and an individual's sense of control over their condition, despite the tendency for functional status to decline.Certain quality of life domains (ie, symptoms and mastery) improved significantly.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine , North Tyneside General Hospital , North Shields, Tyne and Wear , UK.

ABSTRACT

Background: Current guidelines for management of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (COPD) recommend that clinical decisions, including escalation to assisted ventilation, be informed by an estimate of the patients' likely postdischarge quality of life. There is little evidence to inform predictions of outcome in terms of quality of life, psychological well-being and functional status. Undue nihilism might lead to denial of potentially life-saving therapy, while undue optimism might prolong suffering when alternative palliation would be more appropriate. This study aimed to detail longitudinal changes in quality of life following hospitalisation for acute exacerbations of COPD.

Methods: We prospectively recruited two cohorts (exacerbations requiring assisted ventilation during admission and exacerbations not ventilated). Admission clinical data, and mortality and readmission details were collected. Quality of life, psychological well-being and functional status were formally assessed over the subsequent 12 months. Time-adjusted mean change in quality of life was examined.

Results: 183 patients (82 ventilated; 101 not ventilated) were recruited. On average, overall quality of life improved by a clinically important amount in those not ventilated and did not decline in ventilated patients. Both groups showed clinically important improvements in respiratory symptoms and an individual's sense of control over their condition, despite the tendency for functional status to decline.

Conclusions: On average, postdischarge quality of life improved in non-ventilated and did not decline in ventilated patients. Certain quality of life domains (ie, symptoms and mastery) improved significantly. Better understanding of longitudinal change in postdischarge quality of life should help to inform decision-making.

No MeSH data available.


Related in: MedlinePlus