COPD Exacerbation: Why It Is Important to Avoid ICU Admission

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality worldwide. Hospitalization due to acute exacerbations of COPD (AECOPD) is a relevant health problem both for its impact on disease outcomes and on health system resources. Severe AECOPD causing acute respiratory failure (ARF) often requires admission to an intensive care unit (ICU) with endotracheal intubation and invasive mechanical ventilation. AECOPD also acts as comorbidity in critically ill patients; this condition is associated with poorer prognoses. The prevalence reported in the literature on ICU admission rates ranges from 2 to 19% for AECOPD requiring hospitalization, with an in-hospital mortality rate of 20–40% and a re-hospitalization rate for a new severe event being 18% of the AECOPD cases admitted to ICUs. The prevalence of AECOPD in ICUs is not properly known due to an underestimation of COPD diagnoses and COPD misclassifications in administrative data. Non-invasive ventilation in acute and chronic respiratory failure may prevent AECOPD, reducing ICU admissions and disease mortality, especially when associated with a life-threating episode of hypercapnic ARF. In this review, we report on up to date evidence from the literature, showing how improving the knowledge and management of AECOPD is still a current research issue and clinical need.

Prevalence and Factors Affecting Appropriate Inhaler Use in Elderly Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study

“…Overall, 91 patients had a median time [IQR] of COPD diagnosis until hospital admission of 4 [ 2 , 3 , 4 , 5 , 6 ] years. Most of these patients (86.8%) had “more breathlessness”, as indicated by a mMRC score ≥2.…”

“…Chronic obstructive pulmonary disease (COPD) is a heterogeneous respiratory disease that manifests various clinical presentations, including chronic dyspnea, cough, sputum production, and recurrent exacerbations [ 1 , 2 ]. It is typically associated with airway abnormalities (e.g., bronchiolitis) and alveolar destruction, leading to persistent and progressive worsening airflow limitation [ 1 ].…”

Association between admission heart rate and in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: a retrospective cohort study

“…However, individuals with severe disease often experience rapid deterioration and require hospitalization [ 5 ]. AECOPD is one of the most common causes of hospital admission, and those with frequent aggravation experience reduced quality of life and an accelerated decline in lung function [ 6 ]. Respiratory failure (RF) is a complication that contributes the most to the high mortality and poor prognosis of patients with AECOPD [ 7 ].…”

Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review

“…10 It has been shown that patients with COPD hospitalized for AEs have a mortality rate of 25% and 65% at one year and five years, respectively. 11 Approximately 2%-19% of hospitalized AECOPD patients are ultimately transferred to the Intensive Care Unit (ICU), [12][13][14][15] and the ultimate in-hospital mortality rate for such patients is 12-24%, [16][17][18] with 35% of surviving patients expected to be readmitted to the hospital 3 months after discharge. 19,20 Owing to various factors, such as the large population of people with COPD in China and their widespread distribution, limited awareness of the disease among most patients, and unstandardized diagnosis and treatment of COPD primary medical care, most patients are unable to recognize AE at an early stage and cannot receive timely and effective standardized treatment and management.…”