Acute Exacerbation of COPD

Dewan, Naresh A.; Rafique, Salem; Kanwar, Badar; Satpathy, Hemant K.; Ryschon, Kay; Tillotson, Glenn; Niederman, Michael S.

doi:10.1378/chest.117.3.662

Cited by 199 publications

(30 citation statements)

References 12 publications

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“…However, the evidence is conflicting, with Snijders et al [7] more recently reporting no differences in 30-day mortality. Dewan et al [11] reported that patient host factors may determine treatment outcome in acute exacerbation of COPD. They found that host factors such as FEV 1 <35%, the use of home oxygen, frequency of exacerbation, a history of previous pneumonia and sinusitis, and the use of maintenance steroids were independently associated with treatment failure (defined as a return visit for persistent respiratory symptoms that required a change of antibiotic in <4 weeks).…”

Section: Discussionmentioning

confidence: 99%

UK National COPD Resources and Outcomes Project 2008: Patients with Chronic Obstructive Pulmonary Disease Exacerbations Who Present with Radiological Pneumonia Have Worse Outcome Compared to Those with Non-Pneumonic Chronic Obstructive Pulmonary Disease Exacerbations

Myint

Lowe²,

Stone³

et al. 2011

Respiration

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Background: Limited comparative data exist on the outcomes of patients presenting with chronic obstructive pulmonary disease (COPD) exacerbations with or without radiological pneumonia. Objective: To examine the outcome differences amongst these patients. Methods: We analysed 2008 UK National COPD audit data to examine the characteristics, management and outcomes, inpatient- and 90-day mortality and length of stay of patients admitted with COPD exacerbations. Results: Of 9,338 admissions, 16% (1,505) had changes consistent with pneumonia indicated on the admission chest X-ray. They tended to be older (mean ages 75 vs. 72 years), male (53 vs. 50%), more likely to come from care homes, with more disability, higher BMI and co-morbidity, lower albumin but higher urea levels, and less likely to be current smokers. COPD exacerbations with pneumonia were associated with worse outcomes: inpatient mortality was 11 and 7% and 90-day mortality was 17 and 13% for pneumonia and non-pneumonia patients, respectively (p < 0.001). After adjusting for factors that are significantly different between the 2 groups, including age, sex, place of residence, level of disability, co-morbidity, albumin and urea levels, estimated risk ratios for inpatient and 90-day mortality for pneumonia compared to non-pneumonia cases in this series were 1.19 (1.01,1.42) and 1.09 (0.96,1.23), respectively. The adjusted risk ratio of a prolonged acute hospital stay of more than 7 days was 1.15 (1.07, 1.23). Conclusions: Patients who present with radiological pneumonia have worse outcomes compared to those admitted without pneumonia in exacerbation of COPD.

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Section: Discussionmentioning

confidence: 99%

UK National COPD Resources and Outcomes Project 2008: Patients with Chronic Obstructive Pulmonary Disease Exacerbations Who Present with Radiological Pneumonia Have Worse Outcome Compared to Those with Non-Pneumonic Chronic Obstructive Pulmonary Disease Exacerbations

Myint

Lowe²,

Stone³

et al. 2011

Respiration

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“…In other studies, relapse was defined as an event occurring within a maximum period of 4 weeks [7,9,20,21]. …”

Section: Follow-upmentioning

confidence: 99%

“…Several risk factors for relapse after acute exacerbations have been identified. These include the number of previous exacerbations, the use of home oxygen, low lung function, FEV 1 <35%, the absence of a primary caregiver and the choice of oral therapy [6,7,8,9,10,11,12,13,14,15,16]. The question remains: how should a patient with COPD be managed after hospitalization or emergency department visit for an acute exacerbation?…”

Section: Introductionmentioning

confidence: 99%

Management of Chronic Obstructive Pulmonary Disease Patients after Hospitalization for Acute Exacerbation

Osthoff¹,

Leüppi²

2009

Respiration

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The objective of this review is to sum up the literature regarding the management of patients with chronic obstructive pulmonary disease (COPD) after hospitalization for an acute exacerbation. Guidelines recommend a follow-up 4–6 weeks after hospitalization to assess coping strategies, inhaler technique, the need for long-term oxygen therapy and the measurement of FEV₁. This review discusses the follow-up of patients with exacerbations of COPD, the use and value of spirometry in their further management, the potential benefit of home monitoring, the value of long-term oxygen therapy, the value of self-management programs including the use of action plans, the potential benefit of noninvasive ventilation as well as the value of early rehabilitation. There is not enough literature to allow specific recommendations and to define components of a care plan after hospitalization for an acute exacerbation; however, early rehabilitation should be included.

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“…The most common comorbid condition in COPD patients is cardiovascular disease [4, 5]. Furthermore, COPD patients with cardiovascular disease who develop an acute exacerbation have higher mortality [6, 7]. …”

Section: Introductionmentioning

confidence: 99%

Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia

et al. 2013

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There is controversy regarding the impact of chronic obstructive pulmonary disease (COPD) in clinical outcomes in elderly patients with pneumonia. Comorbidities such as cardiovascular disease have been reported to play an important role in patients with acute exacerbations of COPD. However, limited data are available regarding the impact of cardiovascular disease in elderly COPD patients who require hospitalisation for pneumonia. We examined a cohort of subjects with pneumonia and pre-existing COPD. Prior cardiovascular disease was defined as history of myocardial infarction, congestive heart failure, cardiac arrhythmia, unstable angina or stroke. Outcomes examined included 30-day, 90-day, 6-month and 1-year mortality. We included 17 140 elderly COPD patients who were hospitalised for pneumonia. Prior cardiovascular disease was present in 10 240 (59.7%) patients. Prior cardiovascular disease was independently associated with 90-day mortality (21.3% versus 19.4%; hazard ratio (HR) 1.29, 95% CI 1.02–1.17), 6-month mortality (29.0% versus 26.1%; HR 1.28, 95% CI 1.07–1.50) and 12-month mortality (39.2% versus 34.5%; HR 1.33, 95% CI 1.15–1.54) when compared to no prior cardiovascular disease. The temporal differential effect between groups increases from 1.0% at 30 days to 4.7% at 1 year. Prior cardiovascular disease is associated with increased long-term mortality in elderly COPD patients with pneumonia. Differences in mortality rates increased over time.

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Acute Exacerbation of COPD

Cited by 199 publications

References 12 publications

UK National COPD Resources and Outcomes Project 2008: Patients with Chronic Obstructive Pulmonary Disease Exacerbations Who Present with Radiological Pneumonia Have Worse Outcome Compared to Those with Non-Pneumonic Chronic Obstructive Pulmonary Disease Exacerbations

UK National COPD Resources and Outcomes Project 2008: Patients with Chronic Obstructive Pulmonary Disease Exacerbations Who Present with Radiological Pneumonia Have Worse Outcome Compared to Those with Non-Pneumonic Chronic Obstructive Pulmonary Disease Exacerbations

Management of Chronic Obstructive Pulmonary Disease Patients after Hospitalization for Acute Exacerbation

Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia

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