SESSION TITLE: COPD Exacerbation Risk
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 02:45 PM - 04:15 PM
PURPOSE: To assess cognitive functions using Mini Mental State Examination (MMSE) questionnaire in COPD patients who had frequent acute exacerbations in past and to compare them with those COPD patients who had infrequent acute exacerbations in past.
METHODS: The diagnosis of COPD was made as per recent GOLD guidelines. We included 92 eligible COPD patients attending a COPD Clinic at a tertiary level medical college hospital. They were divided into 2 groups on the basis of history of COPD exacerbations during preceding one year: Group 1 (FECOPD Group) included 48 patients who had ≥ 2 acute exacerbations, and Group 2 (I-FECOPD Group) included 44 patients with < 2 acute exacerbations. Patients` clinical data was collected. Spirometric indices were assessed in both groups. MMSE questionnaire was used to assess and compare cognitive functions in both groups.
RESULTS: The mean age of patients in FECOPD group and I-FECOPD group was 62.58±9.61 year and 55.80±11.12 year, respectively. Mean exacerbations in both groups were 2.98±1.25 and 0.55±0.730, respectively. FECOPD group and I-FECOPD group differed significantly with respect to duration of illness (21.73±5.53 year vs. 17.07±5.22 year), FEV1 (1.270±0.247 L vs. 1.711±0.306 L) and PEFR (247.04±49.40 L/min vs. 335.32±61.15 L/min) but not regarding smoking (35.40±10.90 pack years vs. 30.06±10.52 pack years). Cough, expectoration, wheezing and dyspnoea scores were significantly more in FECOPD group. In FECOPD group, MMSE total scores (21.77±2.13 compared to 24.34±1.39) were significantly reduced; all MMSE subset scores were significantly reduced individually. MMSE scores correlated inversely with number of exacerbations, age, duration of illness and correlated directly with spirometric indices. There was no correlation with smoking pack years. Regression model showed frequent acute exacerbations being the strongest predictor of reduction in MMSE score followed by FEV1.
CONCLUSIONS: In our study, cognitive functions were impaired in frequent acute exacerbations group detected using MMSE questionnaire. MMSE scores correlated with number of exacerbations, age, duration of illness and spirometric indices. Frequent acute exacerbations parameter was the strongest predictor of cognitive impairment.
CLINICAL IMPLICATIONS: It is interesting to observe that a simple questionnaire tool, MMSE, was able to provide significant information regarding cognitive dysfunctions in COPD patients with frequent acute exacerbations that may help to improve COPD management.
DISCLOSURE: The following authors have nothing to disclose: Dipti Agarwal, Sushma Sood, Prem Parkash Gupta
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