How do COPD patients respond to exacerbations?

In a multicentre observational study, 121 patients (age 67 ± 11 years, FEV1pred. 48 ± 19) were followed for 6 weeks by daily diary symptom recording. Three types of action were assessed daily: planning periods of rest, breathing techniques and/or sputum clearing (type-A), increased bronchodilator use (type-B) and contacting a healthcare provider (type-C).Type-A action was taken in 70.7%, type-B in 62.7% and type C in 17.3% of exacerbations (n = 75). Smokers were less likely to take type-A and B actions. Type-C actions were associated with more severe airflow limitation and increased number of hospital admissions in the last year.Our study shows that most patients are willing to take timely self-management actions during exacerbations. Future research is needed to determine whether the low incidence of contacting a healthcare provider is due to a lack of self-management or healthcare accessibility.Chronic obstructive pulmonary disease (COPD) is characterised by a progressive decline in respiratory function, exercise capacity and health status [1]. This underlying disease state is interrupted by episodes of acute worsening in respiratory symptoms. If these deteriorations are beyond individual day-to-day variability, these are defined as exacerbations [2]. It is widely recognized that acute exacerbations play a central role in COPD-related morbidity and mortality [1]. Exacerbations are associated with marked physiologic deterioration that may affect disease progression by accelerating reductions in forced expiratory volume in 1 s (FEV1) [3,4], have a significant negative effect on the individual's health-related quality of life (HRQoL) [5,6] and generate an increasing burden on health services and economic costs [7]. Several studies have shown that almost 50% of exacerbations remain unreported and subsequently do not receive adequate treatment [8-10]. Although unreported exacerbations are often considered to be mild, recent studies have shown that these exacerbations m