Predictive value of physiological values and symptom scores for exacerbations of COPD and bronchiectasis (Preprint)

BACKGROUND COPD and bronchiectasis are common and exacerbations contribute to their morbidity and mortality. Predictive factors for frequency of future exacerbations include previous exacerbation frequency and airway colonisation. Earlier treatment of exacerbations is likely to reduce severity. OBJECTIVE To determine whether changes in physiological variables or symptom scores can predict exacerbations of chronic airway disease in participants colonised with Pseudomonas aeruginosa or Haemophilus influenzae METHODS We performed a longitudinal observational cohort study of 30 participants with bronchiectasis and/or COPD, at least 2 exacerbations per year and colonisation with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight and temperature. Exacerbations (defined as the onset of new antibiotics for respiratory symptoms) were collected, and predictive values for abnormal values in the ten days prior to an exacerbation were calculated. RESULTS 30 participants were recruited collecting a total of 39,534 physiological and 25,334 symptom data points across 5,358 participant-days including 78 exacerbations. Peak flow rate and weight were significantly different at the point of exacerbation but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in overall or individually adjusted models. Symptom scores trended to worsening for 10 days either side of an exacerbation, but of insufficient magnitude for prediction with AUROC values of 0.4-0.6. CONCLUSIONS This study demonstrated a lack of utility for either physiological or visual analogue scale symptom predictors in early detection of exacerbations in participants with frequent exacerbation and airway colonisation. This suggests that the self-management education provided as standard of care is superior to either of these other approaches. INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.6636