Patient-Defined Recovery from COPD Exacerbations Differs from Clinical Definitions
New research presented at teh American College of Chest Physicians (CHEST) 2025 Annual Meeting in Chicago, IL, highlights a significant disconnect between how clinicians currently define recovery from acute COPD exacerbations (AECOPD) and how patients and their families actually experience it. Current definitions often rely on health-related quality of life scales like the St.George’s Respiratory Questionnaire and improvements in peak expiratory flow rate. However, investigators argue these measures may not adequately capture the patient’s perspective, perhaps hindering truly patient-centered care.
Researchers, led by Karlic and colleagues, conducted a qualitative study involving 17 patients and 8 family caregivers. A total of 34 paired interviews were completed – with patients interviewed both during and after hospitalization at one of three academic health systems. The patient cohort had a mean age of 67, with a majority (64.7%) identifying as women, Black, and recipients of Medicaid assistance.
Thru detailed transcript analysis and an abductive approach, the team developed a patient-centered model for understanding AECOPD recovery. A key finding was that many patients initially expressed a belief that full recovery from a COPD exacerbation was simply “not possible” due to the progressive nature of the disease. While some anticipated a relatively quick return to baseline, the majority reported incomplete recovery months after discharge.
Patients and caregivers identified four core components defining recovery: functional status, severity of shortness of breath, level of social interaction, and state of mind. Facilitators of recovery were multifaceted, encompassing support from family caregivers, the benefits of physical therapy and home exercise programs, spiritual practices, and the development of effective coping mechanisms. Conversely, barriers included difficulty accepting disease progression, reluctance to seek assistance, uncontrolled anxiety, and persistent respiratory symptoms.
Notably,the study revealed a significant discrepancy between patient-defined recovery and existing clinical definitions. Most patients did not achieve their self-defined recovery goals within 90 days post-discharge, despite clinical definitions suggesting most patients recover within two weeks of leaving the hospital.
“This discrepancy suggests existing definitions of recovery from AECOPD do not align with patient-centered definitions,” the researchers concluded.They emphasize the importance of clinicians actively soliciting and integrating patients’ individual definitions of recovery into discussions surrounding AECOPD to deliver more valuable and patient-focused care. A especially concerning observation was the frequent patient perception that achieving their desired level of recovery was unattainable.
Reference:
karlic K, Lee J, Carter D, Johnson D, et al. How Patients Define Recovery from Acute Exacerbation of COPD Does Not Align with Existing Definitions: A Qualitative Study Using An Abductive Approach. Poster presented at: CHEST Annual Meeting 2025. Chicago, IL. October 19 – 22, 2025.
MacIntyre N, Huang YC.Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5(4):530-535. doi:10.1513/pats.200707-088ET
