Exacerbations, Hospital Admissions and Impaired Health Status in Chronic Obstructive Pulmonary Disease

Abstract

Impaired health status may be a risk factor for frequent exacerbations and hospital admission and, in turn, exacerbations and admissions may further impair the health status of patients with COPD. We have investigated the variables associated with frequent exacerbations (3 or more per year) and admission, with particular interest in health status, in a cohort of ambulatory patients with moderate to severe COPD attended by chest physicians in Spain. A total of 227 investigators included 1057 patients with a mean predicted FEV1 of 41.8%. The mean total score on the St. George's Respiratory Questionnaire (SGRQ) was 47.9 units, and 300 patients (28.4%) had 3 or more exacerbations the previous year and 344 (32.6%) were admitted at least once during the same period. In multivariate analysis only the SGRQ total score was significantly associated with both frequent exacerbations (OR = 1.04; 95% CI = 1.01-2.12; p<0.0001) and admission (OR = 1.01; 95% CI = 1.00-1.02; p = 0.0008). Other variables significantly associated with frequent exacerbations were chronic mucus hypersecretion, increased baseline dyspnea, comorbidity, GOLD stage IV and treatment with inhaled corticosteroids. Variables associated with admission were lower educational level, increased number of exacerbations, use of long-term oxygen therapy and use of short acting beta-2 agonists. An impaired health status is associated with an increased number of exacerbations and with admission to hospital in the previous year. These results, together with previous studies, confirm that impairment in health status in COPD is both a marker of risk for, and a consequence of, frequent exacerbations and admissions.

Determination of Ameliorable Health Impairment Influencing Health-Related Quality of Life among Patients with Silicosis in China: A Cross-Sectional Study

“…These data underline the importance of appropriate amelioration to maintain or improve HRQOL in patients with silicosis. Symptom and activity impairment scores among the patients with silicosis in the present study were similar to those for patients with emphysema or COPD, 25,26 but higher than the scores for communitydwelling men with pneumoconiosis. 8 These high scores were not unexpected, since the patients in the present study were undergoing in-patient treatment for silicosisrelated symptoms.…”

Palliative care needs in COPD patients with or without cancer: an epidemiological study

“…Those exacerbations produce a significant and permanent impairment of health status [5]. Patients with advanced COPD not only suffer from multiple physically burdensome symptoms (e.g.…”

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Therefore, NIV is currently widely used as a first line treatment in patients with severe COPD-AE. The clinical features demonstrated to have an association with the development of COPD-AE include a history of prior COPD-AE, hypercapnia, a lower forced expiratory volume in one second (FEV1) % predicted, the BODE (body mass index (BMI), airflow obstruction, dyspnea and exercise capacity) index, an impaired health status, hypoxemia, pulmonary hypertension and comorbidities (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Although clinical predictors of the development of COPD-AE have been investigated in a number of previous studies, those affecting the need to initiate NIV in stable COPD outpatients who develop COPD-AE have not been sufficiently studied.…”