Importance of the initial behaviour of patients in avoiding late recovery from COPD exacerbations

Background: Reduced forced expiratory volume in 1 second (FEV1), long-term oxygen therapy (LTOT), and frequent exacerbations are considered as risk factors for late recovery (LR) from exacerbations of chronic obstructive pulmonary disease (E-COPD). However, few studies have investigated whether initial behaviour or education status affects recovery from E-COPD. Aim: To test the hypothesis that initial behaviour or education status affects recovery period. Methods: We conducted an observational study of E-COPD patients (n = 115) divided into 2 groups: usual recovery (<2 weeks) and LR (≥2 weeks). The recovery period was determined by relief from symptoms as noted by the patient and his/her physician. Initial behaviour, which was defined within 48 h from E-COPD onset, was classified into 3 types: no action, medication by self-judgment, and visit to a medical institution. Education and psychological statuses before E-COPD were assessed using the Lung Information Needs Questionnaire (LINQ) and Hospital Anxiety and Depression scale, respectively. Results: Of the 201 E-COPD episodes observed, 112 occurred in the LR group. Characteristics of the LR group were as follows: increased deterioration in the BODE index and use of systemic steroids during E-COPD (p < 0.01), use of LTOT, more frequent prior E-COPD, and depression (p < 0.05). The LR group mostly comprised patients who did not take any action within 48 h (p < 0.05). However, the LINQ score was not correlated with LR. Conclusions: Initial behaviour of patients during the early onset of E-COPD was correlated with LR. To avoid LR, each COPD patient should be educated to begin early action in E-COPD.