Clinical and Patient Definitions of Acute COPD Exacerbation Recovery Differ Greatly

Patients and family caregivers living with chronic obstructive pulmonary disease (COPD) define recovery from acute exacerbations differently than traditional clinical measures, according to new qualitative research.1

In a series of semi-structured qualitative interviews with hospitalized patients and their family caregivers, investigator found that the experience of recovery from acute COPD exacerbation was shaped by a combination of physical, emotional, and social factors — not just improvements in lung function or questionnaire scores, as is the clinical standard for recovery.

The data were presented by lead author Kevin Karlic, MD, a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, during the American College of Chest Physicians (CHEST) 2025 Annual Meeting in Chicago, IL, this week.

The existing definitions for recovery from acute COPD exacerbation rely on health-related quality of life scales including the St. George’s Respiratory Questionnaire, as well as improved peak expiratory flow rate scores.2 “However, these definitions may not align with patients’ and family caregivers’ perspectives on recovery, thereby limiting the patient-centeredness of COPD care,” investigators wrote.

Karlic and colleagues conducted the qualitative analysis using input from 17 patients who completed paired interviews both during and after admission to 1 of 3 academic health system hospitals, as well as 8 family caregivers. In total, 34 interviews were conducted with participants. Mean patient age was 67 years old. Eleven (64.7%) patients each were women, Black, and receiving Medicaid assistance.

The team generated a codebook through transcript annotation to help identify patterns in survey responses, applied the codes to all transcripts, then used an abductive approach to develop their own patient-centered model for acute COPD exacerbation recovery.

How do patients define acute COPD exacerbation recovery?

To start, investigators observed that many patients described exacerbation recovery as “not being possible” given the irreversibility of COPD. They struggled to predict their recovery track, but when able, often estimated a short recovery timeline.

In their post-discharge interviews months later, though, a majority of patients described not being fully recovered from their acute exacerbation.

Patients and family caregivers generally defined 4 key measures of acute COPD exacerbation recovery:

• Functional status
• Severity of shortness of breath
• Level of social interaction
• State of mind

Their perceived facilitators of recovery were holistic — ranging from the presence of a family caregiver, the utility of physical therapy and independent home exercise programs, to religious practice and developing effective coping skills.

Their perceived barriers to acute exacerbation recovery included poor acceptance of disease progression, resistance to help, uncontrolled anxiety, and uncontrolled respiratory symptoms. Most patients did not achieve their self-defined recovery within 90 days post-discharge — despite existing definitions of clinical recovery from acute COPD exacerbations consistently demonstrating that most patients recover within 2 weeks of discharge.

“This discrepancy suggests existing definitions of recovery from AECOPD do not align with patient-centered definitions,” Karlic and colleagues wrote. “Therefore, clinicians should seek and integrate patients’ definitions of recovery in conversations regarding AECOPD to ensure delivery of high-value, patient-centric care.”

A concerning trend for clinicians to consider when supporting exacerbation recovery is patients’ perception that the goal itself — as they have defined it — is actually an impossibility.

References

1. 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.
2. 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