Recent improvement in long-term survival after a COPD hospitalisation

Abstract

Background Evidence-based international guidelines on chronic obstructive pulmonary disease (COPD), and their corresponding recommendations, were established to improve individual COPD prognosis, and ultimately to improve survival. The aim of this study was to determine whether the long-term mortality after discharge from a COPD hospitalisation has improved recently, and the effect of co-morbidity treatment in improving COPD prognosis. Methods In a prospective cohort study design of two cohorts 7 years apart, patients discharged from the same university hospital after a COPD exacerbation were followed-up, and their outcomes compared. Demographic and clinical variables, as well as lung function, were collected with the same protocol by the same investigators. Comprehensive assessments of comorbidities and treatments were undertaken. KaplaneMeier survival curves were estimated, and outcomes were compared by means of Cox regression methods. Results Overall, 135 participants in the 1996e7 cohort and 181 participants in the 2003e4 cohort were studied. Both cohorts were comparable in their baseline demographic and clinical variables, and median follow-up was 439 days. The 3-year mortality was lower in the 2003e4 cohort (38.7%) than in the 1996e7 cohort (47.4%) (p¼0.017), and the RR of death after adjustment for gender, age, body mass index, comorbidities, lung function and mMRC (modified Medical Research Council scale) dyspnoea was 0.66 (95% CI 0.45 to 0.97). Long-term survival improved in the second cohort for patients with COPD with heart failure or cancer (p<0.001). Conclusions A recent trend towards better prognosis of patients with COPD after hospital discharge is described and is likely to be associated with better management and treatment of COPD and co-morbidities.

Multicomponent indices to predict survival in COPD: the COCOMICS study

“…S1): Galdakao [11], Pamplona [12], Requena [13], Seville [14], Tenerife [15], Terrassa [16][17][18] and Zaragoza [19]. A minimum data set with age, sex, spirometry and follow-up data in all patients was required.…”

The Impact of Chronic Obstructive Pulmonary Disease and Smoking on Mortality and Kidney Transplantation in End-Stage Kidney Disease

“…The rise in prevalence rates among both sexes may well be explained by improved survival of COPD in the general population over time [11], but also suggests greater acceptance of overall sicker patients for dialysis therapy by nephrologists. It is also tempting to speculate that increased use of tobacco over this period was a major contributory factor, although adjustment for trends in tobacco use did not explain the observed rise in COPD prevalence.…”

Thorax in focus: chronic obstructive pulmonary disease

“…Tantalisingly, the risk of extra-pulmonary malignancy was lower in patients receiving statin therapy. Almagro et al compared outcomes in two cohorts of patients with COPD (recruited after hospitalisation for AECOPD) separated by 7 years (1996/1997 and 2003/2004) 31. The poor prognosis of this sub-population of patients was confirmed but reassuringly 3-year mortality was significantly lower in the more recent cohort (38.7% vs 47.4%).…”