Open Access Highly Accessed Research article

How do COPD patients respond to exacerbations?

Jaap CA Trappenburg1*, David Schaap1, Evelyn M Monninkhof1, Jean Bourbeau2, Gerdien H de Weert-van Oene1, Theo JM Verheij1, Jan-Willem J Lammers3 and Augustinus JP Schrijvers1

Author affiliations

1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands

2 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Center, McGill University, 3650 St. Urbain Street, Montreal, Canada

3 Department of Respiratory Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands

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Citation and License

BMC Pulmonary Medicine 2011, 11:43  doi:10.1186/1471-2466-11-43

Published: 19 August 2011



Although timely treatment of COPD exacerbations seems clinically important, nearly half of these exacerbations remain unreported and subsequently untreated. Recent studies have investigated incidence and impact of failure to seek medical treatment during exacerbations. Yet, little is known about type and timing of other self-management actions in periods of symptom deterioration. The current prospective study aims at determining the relative incidence, timing and determinants of three types of patient responses.


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.