Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) often present with severe acute exacerbations requiring hospital treatment. However, little is known about the prognostic consequences of these exacerbations. A study was undertaken to investigate whether severe acute exacerbations of COPD exert a direct effect on mortality. Methods: Multivariate techniques were used to analyse the prognostic influence of acute exacerbations of COPD treated in hospital (visits to the emergency service and admissions), patient age, smoking, body mass index, co-morbidity, long term oxygen therapy, forced spirometric parameters, and arterial blood gas tensions in a prospective cohort of 304 men with COPD followed up for 5 years. The mean (SD) age of the patients was 71 (9) years and forced expiratory volume in 1 second was 46 (17)%. Results: Only older age (hazard ratio (HR) 5.28, 95% CI 1.75 to 15.93), arterial carbon dioxide tension (HR 1.07, 95% CI 1.02 to 1.12), and acute exacerbations of COPD were found to be independent indicators of a poor prognosis. The patients with the greatest mortality risk were those with three or more acute COPD exacerbations (HR 4.13, 95% CI 1.80 to 9.41). Conclusions: This study shows for the first time that severe acute exacerbations of COPD have an independent negative impact on patient prognosis. Mortality increases with the frequency of severe exacerbations, particularly if these require admission to hospital.

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

“…Additionally, according to a univariate analysis, we detected two statistically significant predictors of the need to initiate NIV: PaCO2 and FEV1% predicted. It is reasonable that both the PaCO2 and FEV1% predicted, which are established prognostic factors in patients with COPD, are also predictors of the need to initiate NIV during exacerbation, given that the need for NIV support implies the development of severe respiratory failure associated with a poor prognosis (1,(24)(25)(26)(27)(28)(29). However, it is noteworthy that, in the multivariate logistic regression analysis, the severity of airway obstruction assessed according to the FEV1% predicted was no longer identified as a predictor.…”

“…Consequently, the PaCO2 is regarded to be a poor prognostic indicator in general and has been demonstrated to be associated with the development of COPD-AE (1,7,(24)(25)(26)(27)(28)(29)(30). However, the majority of studies have focused on severely hypoxemic patients requiring NIV or patients who had previously experienced COPD-AE.…”

“…Acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) is a major cause of hospital admission and is associated with increased mortality, an impaired quality of life and higher health care expenditures (1)(2)(3). Randomized controlled trials have shown that noninvasive ventilation (NIV) reduces the need for endotracheal intubation, reduces complications and increases short-term survival in patients with COPD-AE (4,5).…”

Chronic obstructive pulmonary disease prognostic score: A new index

“…Respiratory emergency admission: Exacerbation is a strong risk factor for death, follow up exacerbation, and future lung function deterioration 29,30 . As a patient suffers from more exacerbations, the prognosis becomes poorer.…”

Caring for the burden of COPD

“…16 These and many other interventions form a rational basis for the management of stable disease and almost certainly decrease hospital admissions and mortality. COPD exacerbations predict future mortality 17 and are related not only to the degree of airflow obstruction but the amount of activity the patient takes, 18 thus providing a rationale for early pulmonary rehabilitation following discharge from hospital. 19 However, having evidence based treatment is only half the battle.…”