University College London, London, UK.
Eur Respir J. 2014 Mar;43(3):735-44. doi: 10.1183/09031936.00110913. Epub 2013 Aug 29.
Uncertainty exists over the ability of the exacerbations of chronic pulmonary disease tool (EXACT) patient-reported outcome diary to quantify exacerbation severity and frequency. To clarify this, we investigated the ability of the EXACT to assess severity of exacerbations and examined the relationship between exacerbations diagnosed using London chronic obstructive pulmonary disease (COPD) cohort diary cards, physician review and symptom-defined events using the EXACT. 58 patients enrolled in the London Chronic Obstructive Pulmonary Disease (COPD) cohort prospectively completed the EXACT during 128 cohort diary card-defined exacerbations between January 2010 and April 2012. Mean ± sd EXACT scores increased from 42.6 ± 8.6 at baseline to 48.0 ± 8.6 at exacerbation onset (p<0.001), and rose further to a maximum score of 54.1 ± 8.9. Maximum EXACT scores were significantly higher in treated than untreated events. Time taken for EXACT scores to return to baseline was significantly related to symptom recovery time as judged by London COPD cohort diary cards, and to peak expiratory flow rate recovery. ∼50% of both diary card-defined and healthcare utilisation exacerbations crossed the EXACT event threshold. However, only 27.9% of diary card-defined and 34.6% of healthcare utilisation exacerbations fully met the criteria for an EXACT event. Patients exhibited smaller rises in the EXACT score at exacerbation as baseline disease severity increased. The EXACT is an effective method of evaluating chronic obstructive pulmonary disease exacerbation severity. However, concerns remain about the ability of the EXACT to accurately detect exacerbations.
在量化慢性肺病加重（EXACT）患者报告结果日记的加重严重程度和频率的能力方面存在不确定性。为了阐明这一点，我们研究了 EXACT 评估加重严重程度的能力，并检查了使用 EXACT 诊断的加重与伦敦慢性阻塞性肺病（COPD）队列日记卡、医生审查和症状定义事件之间的关系。58 名患者前瞻性地参加了伦敦慢性阻塞性肺病（COPD）队列，在 2010 年 1 月至 2012 年 4 月期间完成了 128 次队列日记卡定义的加重事件。EXACT 评分的平均值±标准差从基线时的 42.6±8.6增加到加重开始时的 48.0±8.6（p<0.001），并进一步升高到 54.1±8.9 的最大值。在治疗过的事件中，EXACT 评分的最大值明显高于未治疗的事件。EXACT 评分恢复到基线所需的时间与伦敦 COPD 队列日记卡判断的症状恢复时间以及呼气峰流速恢复显著相关。约 50%的日记卡定义和医疗保健利用的加重事件跨越了 EXACT 事件阈值。然而，只有 27.9%的日记卡定义和 34.6%的医疗保健利用加重事件完全符合 EXACT 事件的标准。随着基线疾病严重程度的增加，患者在加重时 EXACT 评分的升高幅度较小。EXACT 是评估慢性阻塞性肺病加重严重程度的有效方法。然而，仍然存在对 EXACT 准确检测加重的能力的担忧。
