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Comparison of patient-reported outcomes during acute exacerbations of chronic obstructive pulmonary disease
  1. Koichi Nishimura1,
  2. Saya Nakamura2,
  3. Masaaki Kusunose1,
  4. Kazuhito Nakayasu3,
  5. Ryo Sanda1,
  6. Yoshinori Hasegawa2 and
  7. Toru Oga4
  1. 1 Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
  2. 2 Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
  3. 3 Data Research Section, Kondo P.P. Inc., Osaka, Japan
  4. 4 Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  1. Correspondence to Dr. Koichi Nishimura; koichi-nishimura{at}


Introduction The aim of this study was to investigate which patient-reported outcome measure was the best during the recovery phase from severe exacerbation of chronic obstructive pulmonary disease (COPD).

Methods The Exacerbations of Chronic Pulmonary Disease Tool (EXACT), the COPD Assessment Test (CAT), the St George’s Respiratory Questionnaire (SGRQ), the Dyspnoea-12 (D-12) and the Hyland Scale (global scale) were recorded every week for the first month and at 2 and 3 months in 33 hospitalised subjects with acute exacerbation of COPD (AECOPD).

Results On the day of admission (day 1), the internal consistency of the EXACT total score was high (Cronbach’s alpha coefficient=0.89). The EXACT total, CAT, SGRQ total and Hyland Scale scores obtained on day 1 appeared to be normally distributed. Neither floor nor ceiling effects were observed for the EXACT total and SGRQ total scores. The EXACT total score improved from 50.5±12.4 to 32.5±14.3, and the CAT score also improved from 24.4±8.5 to 13.5±8.4 during the first 2 weeks, and the effect sizes (ES) of the EXACT total and CAT score were −1.40 and −1.36, respectively. The SGRQ, Hyland Scale and D-12 were less responsive, with ES of −0.59, 0.96 and −0.90, respectively.

Discussion The EXACT total and CAT scores are shown to be more responsive measures during the recovery phase from severe exacerbation. Considering the conceptual framework, it is recommended that the EXACT total score may be the best measure during the recovery phase from AECOPD. The reasons for the outstanding responsiveness of the CAT are still unknown.

  • COPD exacerbations

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  • Contributors KN contributed, as the principal investigator, to the study concept and design, analysis of the results, and writing of the manuscript. SN, MK and RS contributed to performance of the study and acquisition of data. KN contributed to statistical analysis. YH contributed to the interpretation and editing of the manuscript. TO contributed to statistical analysis, and the interpretation and editing of the manuscript. All authors read and approved the final manuscript.

  • Funding This study was partly supported by the Research Funding for Longevity Sciences (27-10) from the National Center for Geriatrics and Gerontology (NCGG), Japan.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Approved by the Institutional Ethics Committee of the National Center for Geriatrics and Gerontology (no 638-4).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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