Unreported exacerbations are common and their long-term impact on HRQoL has been identified. Previous studies have shown that at least half of all COPD exacerbations identified by symptom worsening were not medically reported and therefore left untreated. SEEMUNGAL et al. [48] demonstrated that unreported exacerbations had similar characteristics to the reported ones. These exacerbations are associated with worsening symptoms worsening when they remain untreated. The short- and long-term impacts of unreported exacerbations on HRLQ were recently reported by XU et al. [49]. In a
multicentre prospective cohort of 491 COPD patients, these investigators demonstrated that more than one unreported exacerbation was associated with significant worsening of the SGRQ score, and HRQoL at 1 yr after adjusting for known confounders. These data suggest that unreported exacerbations may have important long-term impact on patients, and there is an urgent need to develop tools that emphasise early recognition of exacerbations.