PharmacoEconomics

, Volume 23, Issue 4, pp 345–363 | Cite as

Health-related QOL in acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease

A review of the literature
Review Article

Abstract

There is a lack of emphasis on health-related QOL (HR-QOL) changes associated with acute exacerbation of chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD). The aim of this review is to examine the use of HR-QOL instruments to evaluate acute exacerbation of CB or COPD, so as to form recommendations for future research.

A literature search of papers published between 1966 and July 2003 identified more than 300 articles that used acute exacerbation of CB or COPD as the search term. However, only 21 of these studies employed HR-QOL measures as predictors of outcome or in the assessment of the impact, evolution or treatment of acute exacerbations of COPD or CB. A variety of HR-QOL measures were used, both generic and disease specific. The disease-specific St George’s Respiratory Questionnaire (SGRQ), devised for patients with stable CB and with a recall period of 1–12 months, was the most widely used measure, with the Chronic Respiratory disease Questionnaire (CRQ) and the Baseline and Transitional Dyspnoea Index (BDI, TDI) being the only other disease-specific measures used.

Most measures, both generic and disease specific, performed adequately when used during acute exacerbation of CB or COPD and indicated poor HR-QOL during acute exacerbation, which improved on resolution of the exacerbation. Relationships were evident between HR-QOL during an acute exacerbation and various outcomes, including post-exacerbation functional status, hospital readmission for acute exacerbation or COPD, and mortality.

There is a need for studies of treatments for acute exacerbation of CB or COPD to include an appropriate HR-QOL instrument to aid in the stratification of patients so as to target the right treatment to the right patient group. While a new instrument could be developed to measure HR-QOL during acute exacerbation of CB or COPD, currently available disease-specific measures such as the CRQ and the SGRQ appear to be acceptable to patients during acute exacerbation. However, the recall period of the SGRQ symptoms component should be shortened to make it more appropriate for use during acute exacerbation.

References

  1. 1.
    Ball P, Harris JM, Lowson D, et al. Acute infective exacerbations of chronic bronchitis. Q J Med 1995; 88: 61–8Google Scholar
  2. 2.
    Seemungal TAR, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: 1418–22PubMedGoogle Scholar
  3. 3.
    Miravitlles M, Guerrero T, Mayordomo C, et al. on behalf of the EOLO Study Group. Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis. Respiration 2000; 67: 495–501PubMedCrossRefGoogle Scholar
  4. 4.
    Garibaldi RA. Epidemiology of community acquired respiratory tract infections in adults: Incidence, etiology and impact. Am J Med 1995; 78: 32–7CrossRefGoogle Scholar
  5. 5.
    Burrows B, Earle RH. Course and prognosis of chronic obstructive lung disease: a prospective study of 200 patients. N Engl J Med 1969; 280: 397–404PubMedCrossRefGoogle Scholar
  6. 6.
    Miravitlles M, Murio C, Guerrero T, et al. for the DAFNE Study Group. Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest 2002; 121 (5): 1449–55PubMedCrossRefGoogle Scholar
  7. 7.
    Skrepnek GH, Skrepnek SV. Epidemiology, clinical and economic burden, and natural history of chronic obstructive pulmonary disease and asthma. Am J Manag Care 2004; 10: S129–38PubMedGoogle Scholar
  8. 8.
    Ferrer M, Alonso J, Morera J, et al. Chronic obstructive pulmonary disease stage and health related quality of life. Ann Intern Med 1997; 127: 1072–9PubMedGoogle Scholar
  9. 9.
    Schlenk EA, Erlen JA, Dunbar-Jacob J, et al. Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36. Qual Life Res 1998; 7: 57–65PubMedCrossRefGoogle Scholar
  10. 10.
    Moody L, McCormick K, Williams AR. Psychophysiologic correlates of quality of life in chronic bronchitis and emphysema. West J Nurs Res 1991; 13: 336–62PubMedCrossRefGoogle Scholar
  11. 11.
    Curtis JR, Deyo RA, Hudson LD. Health-related quality of life among patients with chronic obstructive pulmonary disease. Thorax 1994; 49: 162–70PubMedCrossRefGoogle Scholar
  12. 12.
    Fletcher C, Peto R. The natural history of chronic airflow obstruction. BMJ 1977; 1: 1645–8PubMedCrossRefGoogle Scholar
  13. 13.
    Miravidles M, Ferrer M, Pont A, et al. for the IMPACT study group. Exacerbations impair quality of life in patients with chronic obstructive pulmonary disease: a two-year follow-up study. Thorax 2004; 59: 387–95CrossRefGoogle Scholar
  14. 14.
    Nicolson P, Anderson P. The patient’s burden: physical and psychological effects of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 2000; 45: 25–32PubMedCrossRefGoogle Scholar
  15. 15.
    Lehnert H, Schuster H-P. Innere medizin. Stuttgart: Ferdinand Enke Verlag, 1998Google Scholar
  16. 16.
    Kanner RE, Anthonisen NR, Connet JE. Lower respiratory illnesses promote FEV t decline in current smokers but not exsmokers with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 164: 358–64PubMedGoogle Scholar
  17. 17.
    Donaldson GC, Seemungal TAR, Bhowmik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847–52PubMedCrossRefGoogle Scholar
  18. 18.
    Curtis JR, Martin DP, Martin TR. Patient-assessed health outcomes in chronic lung disease: what are they, how do they help us, and where do we go from here? Am J Respir Crit Care Med 1997; 156: 1032–9PubMedGoogle Scholar
  19. 19.
    Ketelaars CAJ, Schlosser MAG, Mostert RT, et al. Determinants of health-related quality of life in patients with chronic obstructive pulmonary disease. Thorax 1996; 51: 39–43PubMedCrossRefGoogle Scholar
  20. 20.
    Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997; 155: 1283–9PubMedGoogle Scholar
  21. 21.
    McSweeney AJ, Heaton RK, Grant I, et al. Chronic obstructive pulmonary disease: socioemotional adjustment and quality of life. Chest 1982; 77: 309–11CrossRefGoogle Scholar
  22. 22.
    Okubadejo AA, Jones PW, Wedzicha JA. Quality of life in patients with chronic obstructive pulmonary disease and severe hypoxemia. Thorax 1996; 51: 44–7PubMedCrossRefGoogle Scholar
  23. 23.
    Aaron SD, Vandemheen KL, Hebert P, et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med 2003; 348: 2618–25PubMedCrossRefGoogle Scholar
  24. 24.
    Aaron SD, Vandemheen KL, Clinch JJ, et al. Measurement of short-term changes in dyspnoea and disease-specific quality of life following an acute COPD exacerbation. Chest 2002; 121 (3): 688–96PubMedCrossRefGoogle Scholar
  25. 25.
    Almagro P, Calbo E, de Echagden AO, et al. Mortality after hospitalisation for COPD. Chest 2002; 121: 1441–8PubMedCrossRefGoogle Scholar
  26. 26.
    Andersson I, Johansson K, Larsson S, et al. Long-term oxygen therapy and quality of life in elderly patients hospitalised due to severe exacerbation of COPD: a 1 year follow-up study. Respir Med 2002; 96: 944–9PubMedCrossRefGoogle Scholar
  27. 27.
    Anie K, Lowton K, Jones PW. Changes in health status following an acute infective exacerbation of COPD [abstract]. Fur Respir J 1997; 10: 148SGoogle Scholar
  28. 28.
    Behnke M, Taube C, Kirsten D, et al. Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease. Respir Med 2000; 94: 1184–91PubMedCrossRefGoogle Scholar
  29. 29.
    Connors AF, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 154: 959–67PubMedGoogle Scholar
  30. 30.
    Davies L, Wilkinson M, Bonner S, et al. “Hospital at home” versus hospital care in patients with exacerbations of chronic obstructive pulmonary disease: prospective randomised controlled trial. BMJ 2000; 321: 1265–8PubMedCrossRefGoogle Scholar
  31. 31.
    Dellamonica P, Reman A, Chiche D, et al. Traitement des exacerbations des bronchitis chroniques: c6furoxime IM avec relais per os par c6furoxime axetil versus ceftriaxone IM. Med Mal Infect 1997; 27: 294–300CrossRefGoogle Scholar
  32. 32.
    Doll H, Grey-Amante P, Duprat-Lomon I, et al. Quality of life in acute exacerbation of chronic bronchitis: results from a German population study. Respir Med 2002; 96: 39–51PubMedCrossRefGoogle Scholar
  33. 33.
    Doll H, Duprat-Lomon I, Ammerman E, et al. Validity of the St George’s respiratory questionnaire at acute exacerbation of chronic bronchitis: comparison with the Nottingham health profile. Qual Life Res 2003; 12: 117–32PubMedCrossRefGoogle Scholar
  34. 34.
    Garcia-Aymerich J, Farrero E, Félez MA, et al. Risk factors of re-admission to hospital for a COPD exacerbation: a prospective study. Thorax 2003; 58: 100–5PubMedCrossRefGoogle Scholar
  35. 35.
    Grossman R, Mukhegjee J, Vaughan D, et al. for the Canadian Ciprofloxacin Health Economic Study Group. A 1-year community-based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis. Chest 1998; 113 (7): 131–41PubMedCrossRefGoogle Scholar
  36. 36.
    Lorenz J, Thate-Waschke IM, Mast O, et al. Treatment outcomes in acute exacerbations of chronic bronchitis: comparison of macrolides and moxifloxacin from the patient perspective. J Int Med Res 2001; 29: 74–86PubMedGoogle Scholar
  37. 37.
    Lynn J, Ely W, Zhong Z, et al. Living and dying with chronic obstructive pulmonary disease. J Am Geriatr Soc 2000; 48: S91–S100PubMedGoogle Scholar
  38. 38.
    Osman LM, Godden DJ, Friend JAR, et al. Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax 1997; 52: 67–71PubMedCrossRefGoogle Scholar
  39. 39.
    Patterson C, Langan CE, McKaig GA, et al. Assessing patient outcomes in acute exacerbation of chronic bronchitis: the measure your medical outcome profile (MYMOP), medical outcomes study 6-item general health survey (MOS-6A) and EuroQoL (EQ-5D). Qual Life Res 2000; 9: 521–7CrossRefGoogle Scholar
  40. 40.
    Saundy-Unterberger H, Martin JG, Gray-Donald K. Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997; 156: 794–9Google Scholar
  41. 41.
    Schouenborg P, Gerdes N, Rasmussen HH, et al. Azithromycin versus pivampicillin in the treatment of acute exacerbations of chronic bronchitis: a single-blind, double-dummy, multicentre study. J Int Med Res 2000; 28: 101–10PubMedGoogle Scholar
  42. 42.
    Seneff MG, Wagner DP, Wagner RP, et al. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 1995; 274: 1852–7PubMedCrossRefGoogle Scholar
  43. 43.
    Spencer S, Jones PW, for the GLOBE Study Group. Time course of recovery of health status following an infective exacerbation of chronic bronchitis. Thorax 2003; 58: 589–93PubMedCrossRefGoogle Scholar
  44. 44.
    Bach PB, Brown C, Gelfand SE, et al. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern Med 2001; 134 (7): 600–20PubMedGoogle Scholar
  45. 45.
    Blanchard AR. Treatment of COPD exacerbations: pharmacologic options and modification of risk factors. Postgrad Med 2002; 111 (6): 65–8, 71-2, 75PubMedCrossRefGoogle Scholar
  46. 46.
    Calverley PMA. Modern treatment of chronic obstructive pulmonary disease. Fur Respir J 2001; 18 Suppl. 34: 60S–6SCrossRefGoogle Scholar
  47. 47.
    Camargo CA. The relationship between COPD exacerbations and other outcomes. Fur Respir Rev 2002; 12: 9–10Google Scholar
  48. 48.
    Morris S, Anderson P, Irwin DE. Acute exacerbations of chronic bronchitis: a pharmacoeconomic review of antibacterial use. Pharmacoeconomics 2002; 20 (3): 153–68PubMedCrossRefGoogle Scholar
  49. 49.
    Perfetto EM, Mullins CD, Subedi P, et al. Selection of clinical, patient-reported, and economic end points in acute exacerbation of chronic bronchitis. Clin Ther 2001; 23 (10): 1747–72PubMedCrossRefGoogle Scholar
  50. 50.
    Sohy C, Pilette C, Niederman MS, et al. Acute exacerbation of chronic obstructive pulmonary disease and antibiotics: what studies are still needed? Fur Respir J 2002; 19: 966–75CrossRefGoogle Scholar
  51. 51.
    Jones PW, Quirk FH, Baveystock CM, et al. A self-complete measure of health status for chronic airflow limitation: the St George’s Respiratory Questionnaire. Respir Med 1991; 85: 2531Google Scholar
  52. 52.
    Jones PW. Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Fur Respir J 2002; 19: 398–404CrossRefGoogle Scholar
  53. 53.
    Jaeschke R, Singer J, Guyatt GH. Measurement of health status ascertaining the minimal clinically important difference. Control Clin Trials 1989; 10: 407–15PubMedCrossRefGoogle Scholar
  54. 54.
    Peach H, Pathy MS. Follow-up study of disability among elderly patients discharged from hospital with exacerbations of chronic bronchitis. Thorax 1981; 36: 585–9PubMedCrossRefGoogle Scholar
  55. 55.
    Wu AW, Damiano AM, Lynn J, et al. Predicting future functional status for seriously ill hospitalised adults. The SUPPORT prognostic model. Ann Intern Med 1995; 122: 342–50Google Scholar
  56. 56.
    Smucny JJ, Becker LA, Glazier RH, et al. Are antibiotics effective treatment for acute bronchitis? A meta-analysis. J Fam Pract 1998; 47: 453–60PubMedGoogle Scholar
  57. 57.
    Leidy NK, Margolis MK, Anton SF, et al. Health-related quality of life effects and outcomes of treatment in patients with COPD. Fur Respir Rev 2002; 12: 83, 79-86Google Scholar
  58. 58.
    Bowling A. Measuring disease: a review of disease specific quality of life measurement scales. Philadelphia (PA): Open University Press, 2001: 149–74Google Scholar
  59. 59.
    Chen Y, Breithaupt K, Muhajarine N. Occurrence of chronic obstructive pulmonary disease among Canadians and sexrelated risk factors. J Clin Epidemiol 2000; 53: 755–61PubMedCrossRefGoogle Scholar
  60. 60.
    Del Donno M, Olivieri D. Mucoactive drugs in the management of chronic obstructive pulmonary disease. Monaldi Arch Chest Dis 1998 Dec; 53 (6): 714–9PubMedGoogle Scholar
  61. 61.
    DiLorenzo G, Morici G, Drago A, et al. Efficacy, tolerability, and effects on quality of life of inhaled salmeterol and oral theophylline in patients with mild-to-moderate chronic obstructive pulmonary disease. Clin Ther 1998; 20: 1130–48CrossRefGoogle Scholar
  62. 62.
    Fishman AP. Pulmonary rehabilitation research. Am J Crit Care Med 1994; 149: 825–33Google Scholar
  63. 63.
    Morgan MDL. Experience of using the CRQ (Chronic Respiratory Questionnaire). Respir Med 1991; 85 Suppl. B: 23–4PubMedCrossRefGoogle Scholar
  64. 64.
    Taytard A, Cousson F. Symptoms and life of patients with chronic bronchitis: preliminary results. Rev Pneumol Clin 1996; 52 (6: 379–85PubMedGoogle Scholar
  65. 65.
    Maille AR, Koning CJ, Zwinderman AH, et al. The development of the Quality of Life for Respiratory Illness Questionnaire (QoL-RIQ): a disease-specific quality of life question naire for patients with mild to moderate chronic non-specific lung disease. Respir Med 1997 May; 91 (5): 297–309PubMedCrossRefGoogle Scholar
  66. 66.
    Miravitlles M, Alvarez-Sala JL, Lamarca R, et al. for the IMPAC Study Group. Treatment and quality of life in patients with chronic obstructive pulmonary disease. Qual Life Res 2002; 11: 329–38PubMedCrossRefGoogle Scholar
  67. 67.
    Tsukino M, Nishimura K, Ikeda A, et al. Physiologic factors that determine the health-related quality of life in patients with COPD. Chest 1996; 111 (4): 896–903CrossRefGoogle Scholar
  68. 68.
    Seemungal TAR, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 1608–13PubMedGoogle Scholar
  69. 69.
    Niewoehner DE, Collins D, Erbland ML. Relation of FEV(1) to clinical outcomes during exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Coopera tive Study Group. Am J Respir Crit Care Med 2000; 161: 1201–5PubMedGoogle Scholar
  70. 70.
    Yohannes AM, Room J, Waters K, et al. Quality of life in elderly patients with COPD: measurement and predictive factors. Respir Med 1998; 92: 1231–6PubMedCrossRefGoogle Scholar
  71. 71.
    Wegner RA, Jörres RA, Kirsten DK, et al. Factor analysis of exercise capacity, dyspnoea ratings and lung function in patients with severe COPD. Fur Respir J 1994; 7: 725–9CrossRefGoogle Scholar
  72. 72.
    Hajiro T, Nishimura K, Tsukino M, et al. Analysis of clinical methods used to evaluate dyspnea in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 158: 1185–9PubMedGoogle Scholar
  73. 73.
    Jones PW. Health status measurement in COPD. Thorax 2001; 56: 880–7PubMedCrossRefGoogle Scholar
  74. 74.
    Brusasco V, Hodder R, Miravitlles M, et al. Health outcomes following six months treatment with once daily tiotropium compared to twice daily salmeterol in patients with COPD. Thorax 2003; 58: 399–404PubMedCrossRefGoogle Scholar
  75. 75.
    Barr IT, Schumacher GE, Freeman S, et al. American translation, modification, and validation of the St. George’s Respiratory Questionnaire. Clin Ther 2000; 22: 1121–45CrossRefGoogle Scholar
  76. 76.
    Rutten-van Mölken M, Roos B, Van Noord JA. An empirical comparison of the St. George’s Respiratory Questionnaire (SGRQ and the Chronic Respiratory Disease Questionnaire (CRQ in a clinical trial setting. Thorax 1999; 54: 995–1003PubMedCrossRefGoogle Scholar
  77. 77.
    Grossman RF. How do we achieve cost-effective options in lower respiratory tract infection therapy? Chest 1998; 113 (3S): 205S–1 OSPubMedCrossRefGoogle Scholar
  78. 78.
    Wilson R, Wilson C. Defining subsets of patients with chronic bronchitis. Chest 1997; 112: 303S–9SPubMedCrossRefGoogle Scholar
  79. 79.
    Adams SG, Melo J, Luther M, et al. Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD. Chest 2000; 117 (5): 1345–52PubMedCrossRefGoogle Scholar
  80. 80.
    Miravitlles M. Designing future clinical trials for acute exacerbations of chronic bronchitis. In: Allegra L, Blasi F, editors. Mechanisms and management of COPD exacerbations. Milano: Springer-Verlag, 2000: 88–99CrossRefGoogle Scholar
  81. 81.
    Perkins HS. Using outcome predictions to make treatment decisions. Chest 1987; 91: 475–6PubMedCrossRefGoogle Scholar
  82. 82.
    Menzies R, Gibbons W, Goldberg P. Determinants of weaning and survival among patient with COPD who require mechanical ventilation for acute respiratory failure. Chest 1989; 95: 398–405PubMedCrossRefGoogle Scholar
  83. 83.
    Ortqvist A. Treatment of community-acquired lower respiratory tract infections in adults. Fur Respir J 2002; 20 (36S): 40S–53SCrossRefGoogle Scholar
  84. 84.
    Snow V, Lascher S, Mottur-Pilson C. The evidence base for management of acute exacerbations of COPD. Chest 2001; 119: 1185–9Google Scholar
  85. 85.
    White AJ, Gompertz S, Stockley RA. Chronic obstructive pulmonary disease 6: the aetiology of exacerbations of chronic obstructive pulmonary disease. Thorax 2003; 58: 73–80 HR-QOL in Acute Exacerbations of Chronic Bronchitis and COED 363PubMedCrossRefGoogle Scholar
  86. 86.
    Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in acute exacerbation of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204PubMedGoogle Scholar
  87. 87.
    Wilson R, Grossman R. Introduction: the role of bacterial infection in chronic bronchitis. Semin Respir Infect 2000; 15 (1): 16CrossRefGoogle Scholar
  88. 88.
    Miravitlles M. Epidemiology of chronic obstructive pulmonary disease exacerbations. Clin Pulm Med 2002; 9 (4): 1–7CrossRefGoogle Scholar
  89. 89.
    Miravitlles M, Murio C, Guerrero T, et al. on behalf of the DAFNE study group. Factors associated with relapse after ambulatory treatment of acute exacerbations of chronic bronchitis. Fur Respir J 2001; 17: 928–33CrossRefGoogle Scholar
  90. 90.
    Asmundsson T, Kilburn KH. Survival after acute respiratory failure: 145 patients observed 5 to 8 and one-half years. Ann Intern Med 1974; 80: 54–7PubMedGoogle Scholar
  91. 91.
    Burk RH, George RB. Acute respiratory failure in chronic obstructive pulmonary disease: immediate and long-term prognosis. Arch Intern Med 1973; 132: 865–8PubMedCrossRefGoogle Scholar
  92. 92.
    Sluiter III, Blokzijl EJ, van Dijl W, et al. Conservative and respirator treatment of acute respiratory insufficiency in patients with chronic obstructive lung disease: a reappraisal. Am Rev Respir Dis 1972; 105: 932–43PubMedGoogle Scholar
  93. 93.
    Teno JM, Harrell FE, Knaus W, et al. Prediction of survival for older hospitalised patients: the HELP survival model. J Am Geriatr Soc 2000; 48 (5 Suppl.): S16–24PubMedGoogle Scholar
  94. 94.
    Vandenbergh E, van de Woestlijne KP, Gyslen A. Conservative treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1968; 98: 60–9PubMedGoogle Scholar
  95. 95.
    Warren PM, Millar IS, Fenley DC, et al. Respiratory failure revisited: acute exacerbations of chronic bronchitis between 1961-1968 and 1970-1976. Lancet 1980; 1: 467–71PubMedCrossRefGoogle Scholar
  96. 96.
    Read RC. Infection in acute exacerbations of chronic bronchitis: a clinical perspective. Respir Med 1999; 93: 845–50PubMedCrossRefGoogle Scholar
  97. 97.
    Adams SG, Anzueto A. Antibiotic therapy in acute exacerbations of chronic bronchitis. Semin Respir Infect 2000; 15 (3): 234–47PubMedCrossRefGoogle Scholar
  98. 98.
    McCrory DC, Brown C, Gelfand SE, et al. Management of acute exacerbations of COPD. Chest 2001; 119: 1190–209PubMedCrossRefGoogle Scholar
  99. 99.
    Niederman MS. Antibiotic therapy of exacerbations of chronic bronchitis. Semin Respir Infect 2000; 15 (1): 59–70PubMedCrossRefGoogle Scholar
  100. 100.
    Saint S, Bent S, Vittinghoff E, et al. Antibiotics in chronic pulmonary disease exacerbations: a meta-analysis. JAMA 1995; 273: 957–60PubMedCrossRefGoogle Scholar
  101. 101.
    Dewan NA, Rafique S, Kanwar B, et al. Acute exacerbation of COPD: factors associated with poor treatment outcome. Chest 2000; 117: 662–71PubMedCrossRefGoogle Scholar
  102. 102.
    Rowe BH, Oxman AD. Performance of an asthma quality of life questionnaire in an outpatient setting. Am Rev Respir Dis 1993; 148: 675–81PubMedCrossRefGoogle Scholar
  103. 103.
    Kanga J, Kuhn R, Craigmyle L, et al. Cystic fibrosis clinical score: a new scoring system to evaluate acute pulmonary exacerbation. Clin Ther 1999; 21 (8): 1343–56PubMedCrossRefGoogle Scholar
  104. 104.
    Evans AT, Husain S, Durairaj L, et al. Azithromycin for acute bronchitis: a randomised, double-blind, controlled trial. Lancet 2002; 359: 1648–54PubMedCrossRefGoogle Scholar
  105. 105.
    Yohannes AM, Hardy CC. Treatment of chronic obstructive pulmonary disease in older patients: a practical guide. Drugs Aging 2003; 20: 209–28PubMedCrossRefGoogle Scholar

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© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Oxford, Outcomes, Old Barn, Jericho FarmCassington, OxfordUK
  2. 2.Servei de Pneumologia, Institut Clínic de Pneumologia I Cirurgia Toràcica (IDIBAPS)Hospital ClínicBarcelonaSpain

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