Risk Factors for Hospitalization for a Chronic Obstructive Pulmonary Disease Exacerbation

Abstract

Although exacerbation of chronic obstructive pulmonary disease (COPD) is important in terms of health and costs, there is little information about which are the risk factors. We estimated the association between modifiable and nonmodifiable potential risk factors of exacerbation and the admission for a COPD exacerbation, using a case-control approach. Cases were recruited among admissions for COPD exacerbation during 1 yr in four tertiary hospitals of the Barcelona area. Control subjects were recruited from hospital's register of discharges, having coincided with the referent case in a previous COPD admission but being clinically stable when the referent case was hospitalized. All patients completed a questionnaire and performed spirometry, blood gases, and physical examination. Information about potential risk factors was collected, including variables related to clinical status, characteristics of medical care, medical prescriptions, adherence to medication, lifestyle, quality of life, and social support. A total of 86 cases and 86 control subjects were included, mean age 69 yr, mean FEV(1) 39% of predicted. Multivariate logistic regression showed the following risk (or protective) factors of COPD hospitalization: three or more COPD admissions in the previous year (odds ratio [OR] 6.21, p = 0.008); FEV(1) (OR 0.96 per percentual unit, p < 0.0005); underprescription of long-term oxygen therapy (LTOT) (OR 22.64, p = 0.007); and current smoking (OR 0.30, p = 0.022). Among a wide range of potential risk factors we have found that only previous admissions, lower FEV(1), and underprescription of LTOT are independently associated with a higher risk of admission for a COPD exacerbation.

Nonpharmacological treatment and relief of symptoms in COPD: Table 1—

“…Frequency of AECOPDs increases with disease severity, as represented by airflow obstruction [100], although the relationship between AECOPD frequency and severity of airflow obstruction is not particularly close and new evidence indicates a possible role of extrapulmonary factors in the genesis of exacerbation [101]. Indeed, the most severe COPD patients, especially those with several comorbid conditions, are prone to more severe exacerbations and are likely to require hospital admission, especially during the winter months, when respiratory viral infections are common [102].…”

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.…”

Factors Associated with Hospital Admission among Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

“…1 Despite the tremendous burden of hospital admissions and ED visits caused by COPD exacerbations, little is known regarding factors associated with hospital admission from the ED. Previous studies focused on risk factors for admission in stable COPD patients, 2,3 external factors (e.g., air pollution) and admission, 4 or prognostic factors for in-hospital mortality. [5][6][7] However, these studies did not address the decision making for admission among patients presenting to the ED with COPD exacerbations.…”