PURPOSE: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) impair quality of life, accelerate the declining lung function and need frequent hospitalisations leading to increased healthcare burden. By identifying pre-symptomatic patients clinically before becoming ill due to AE-COPD and treating them rationally not only the hospital admission could be avoided but progression of Chronic Obstructive Pulmonary Disease (COPD) could be slowed.The aim of the study was to determine the factors associated with hospital admission among adults who are admitted with AE-COPD.
METHODS: All the patients in the study were subjected to a questionnaire based interview during their hospitalization. Data on body mass index, smoking, symptoms, course of the disease management and outcome during the hospitalization were obtained. Increase in intensity of symptoms, smoking habit, onset of new physical signs, failure to initial medical management, history of repeated hospital admissions in last one year and co-morbidities were recorded. Univariate analysis was performed with initial parameters, the co-morbidities were independent variables and the hospital admissions were considered as dependent variables. Significant variables were considered for multivariate regression analysis.
RESULTS: Out of 96 patients, 73 patients met the inclusion criteria for the study. The hospitalisation due to AE-COPD was associated with the declining forced expiratory flow volume in the first second (FEV1) (OR 1.365; CI1.067-3.768; P=0.037), declining expiratory flow rate (OR 1.835; CI 1.117-3.012; P=0.046), increasing sputum purulence (OR: 1.731; CI 0.914-3.132; P=0.039), the number of hospitalisations during previous year for COPD (OR 1.963; CI 1.037-3.814; P=0.048) and co-morbidities(OR 2.373; CI 1.231-3.127; P=0.041). Sputum purulence is a new factor associated with AE-COPD.
CONCLUSION: The study shows both disease and healthcare related factors are the predictors for hospitalisation. Early identification of the risk factors and necessary treatment may be helpful in reducing frequency of hospitalisations due to AE-COPD.
CLINICAL IMPLICATIONS: The clinical assessment of the predictors of exacerbations in pre-symptomatic patients before becoming ill due to AE-COPD and treating them rationally should reduce hospitalisations.
DISCLOSURE: Prasanta Mohapatra, No Financial Disclosure Information; No Product/Research Disclosure Information