Background: COPD is a complex disease with
exacerbations characterized by worsening of symptoms resulting in
deteriorating lung function.
Study objective: To
assess predictive factors of relapse for patients with acute
exacerbations of COPD (AECB).
cohort analysis of visits for AECB.
Affairs Medical Center.
Patients: Three hundred
sixty-two visits (173 patients) with documented COPD treated as
outpatients for AECB.
Measurements: Severity of
underlying COPD, severity of AECB, comorbid conditions, therapy, and
relapse rates (return visit within 14 days with persistent or worsening
Results: Each visit was analyzed
individually (referred to as a patient-visit). One group
received antibiotics (270 patient-visits), and the second group (92
patient-visits) did not. Both groups had similar demographics and
severity of underlying COPD. The overall relapse rate was 22%. The
majority of patient-visits (95%) with severe symptoms at presentation
were prescribed antibiotics vs only 40% of those with mild symptoms.
Twenty-nine of 92 patient-visits (32%) were followed by relapse in the
group that was not given antibiotics, whereas only 50 of 270 (19%)
treated with antibiotics relapsed (p < 0.001). Those treated with
amoxicillin had an even higher relapse rate (20 of 37 patient-visits,
or 54%) than those who did not receive antibiotics (p = 0.006).
Conclusions: Relapse from AECB was not related to the
severity of underlying disease or to the severity of the acute
exacerbation. Patients treated with antibiotics had significantly lower
relapse rates than those who did not receive antibiotics. However, the
specific choice of antibiotic is important because those treated with
amoxicillin had the highest relapse rates of all