Validity of an automated telephonic system to assess COPD exacerbation rates

• Published in: The European respiratory journal Vol. 39; no. 5; pp. 1090 - 1096
• Main Authors: BISCHOFF, Erik W. M. A, BOER, Lonneke M, MOLEMA, Johan, AKKERMANS, Reinier, WEEL, Chris Van, VERCOULEN, Jan H, SCHERMER, Tjard R. J
• Format: Journal Article
• Language: English
• Published: Leeds Maney 01.05.2012
• Subjects: Aged; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Disease Progression; Female; Health Surveys - methods; Humans; Male; Medical sciences; Middle Aged; Patient Compliance - statistics & numerical data; Patient Preference - statistics & numerical data; Pneumology; Prospective Studies; Pulmonary Disease, Chronic Obstructive - pathology; Reproducibility of Results; Telephone; Lung disease; Validity; Chronic; Sensitivity; Specificity; Respiratory disease; exacerbations; Bronchus disease; Chronic obstructive pulmonary disease; Obstructive pulmonary disease; Pneumology
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/09031936.00057811

Current tools for recording chronic obstructive pulmonary disease (COPD) exacerbations are limited and often lack validity testing. We assessed the validity of an automated telephonic exacerbation assessment system (TEXAS) and compared its outcomes with existing tools. Over 12 months, 86 COPD patients (22.1% females; mean age 66.5 yrs; mean post-bronchodilator forced expiratory volume in 1 s 53.4% predicted) were called once every 2 weeks by TEXAS to record changes in respiratory symptoms, unscheduled healthcare utilisation and use of respiratory medication. The responses to TEXAS were validated against exacerbation-related information collected by observations made by trained research assistants during home visits. No care assistance was provided in any way. Diagnostic test characteristics were estimated using commonly used definitions of exacerbation. Detection rates, compliance and patient preference were assessed, and compared with paper diary cards and medical record review. A total of 1,824 successful calls were recorded, of which 292 were verified by home visits (median four calls per patient, interquartile range three to five calls per patient). Independent of the exacerbation definition used, validity was high, with sensitivities and specificities between 66% and 98%. Detection rates and compliance differed extensively between the different tools, but were highest with TEXAS. Patient preference did not differ. TEXAS is a valid tool to assess COPD exacerbation rates in prospective clinical studies. Using different tools to record exacerbations strongly affects exacerbation occurrence rates.