Outcomes of Severe COPD Exacerbations Requiring Hospitalization

ABSTRACT

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important events in the lives of patients with COPD. While several definitions exist for AECOPD, exacerbations that result in a hospitalization would nearly always be considered severe. On average, exacerbation rates are ∼1 to 2 per patient-year with COPD hospitalizations averaging ∼0.1 to 0.2 per patient-year. Many risk factors, some of which are modifiable, such as patient adherence to therapy, pulmonary rehabilitation, and type of medication used, influence the rate of AECOPD. Severe AECOPD that result in hospitalization often lead to several adverse affects, including decreased quality of life, diminished lung function, weakness, reexacerbations/rehospitalization, cardiopulmonary complications, and death. Preventing severe AECOPD and their sequelae is a critical component in treating our patients with COPD.

KEYWORDS

COPD - exacerbations - outcomes - hospitalization - epidemiology

REFERENCES

• 1 Rabe K F, Hurd S, Anzueto A Global Initiative for Chronic Obstructive Lung Disease et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.  Am J Respir Crit Care Med. 2007;  176 532-555
• 2 Mannino D M, Buist A S. Global burden of COPD: risk factors, prevalence, and future trends.  Lancet. 2007;  370 765-773
• 3 Mannino D M, Braman S. The epidemiology and economics of chronic obstructive pulmonary disease.  Proc Am Thorac Soc. 2007;  4 502-506
• 4 Holguin F, Folch E, Redd S C, Mannino D M. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001.  Chest. 2005;  128 2005-2011
• 5 Johnston A K, Mannino D M. Epidemiology of COPD exacerbations. In: Wedzicha JA, Martinez FJ Exacerbations of Chronic Obstructive Pulmonary Disease. London, UK; Informa Healthcare 2008: 15-26
• 6 Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations.  Chest. 2000;  117(5, Suppl 2) 398S-401S
• 7 Effing T W, Kerstjens H A, Monninkhof E M et al.. Definitions of exacerbations: does it really matter in clinical trials on COPD?.  Chest. 2009;  136 918-923
• 8 Celli B R, MacNee W. ATS/ERS Task Force . Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.  Eur Respir J. 2004;  23 932-946
• 9 Bahadori K, FitzGerald J M, Levy R D, Fera T, Swiston J. Risk factors and outcomes associated with chronic obstructive pulmonary disease exacerbations requiring hospitalization.  Can Respir J. 2009;  16 e43-e49
• 10 Briggs A, Spencer M, Wang H, Mannino D, Sin D D. Development and validation of a prognostic index for health outcomes in chronic obstructive pulmonary disease.  Arch Intern Med. 2008;  168 71-79
• 11 de Melo M N, Ernst P, Suissa S. Rates and patterns of chronic obstructive pulmonary disease exacerbations.  Can Respir J. 2004;  11 559-564
• 12 Balcells E, Antó J M, Gea J PAC-COPD Study Group et al. Characteristics of patients admitted for the first time for COPD exacerbation.  Respir Med. 2009;  103 1293-1302
• 13 Garcia-Aymerich J, Barreiro E, Farrero E, Marrades R M, Morera J, Antó J M. Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study).  Eur Respir J. 2000;  16 1037-1042
• 14 Garcia-Aymerich J, Monsó E, Marrades R M EFRAM Investigators et al. Risk factors for hospitalization for a chronic obstructive pulmonary disease exacerbation. EFRAM study.  Am J Respir Crit Care Med. 2001;  164 1002-1007
• 15 Vestbo J, Rasmussen F V. Respiratory symptoms and FEV1 as predictors of hospitalization and medication in the following 12 years due to respiratory disease.  Eur Respir J. 1989;  2 710-715
• 16 Dial S, Menzies D. Is there a role for mask continuous positive airway pressure in acute respiratory failure due to COPD? Lessons from a retrospective audit of 3 different cohorts.  Int J Chron Obstruct Pulmon Dis. 2006;  1 65-72
• 17 Chandra D, Tsai C L, Camargo Jr C A. Acute exacerbations of COPD: delay in presentation and the risk of hospitalization.  COPD. 2009;  6 95-103
• 18 Lee T A, Schumock G T, Bartle B, Pickard A S. Mortality risk in patients receiving drug regimens with theophylline for chronic obstructive pulmonary disease.  Pharmacotherapy. 2009;  29 1039-1053
• 19 Patel I S, Seemungal T A, Wilks M, Lloyd-Owen S J, Donaldson G C, Wedzicha J A. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations.  Thorax. 2002;  57 759-764
• 20 Groenewegen K H, Postma D S, Hop W C, Wielders P L, Schlösser N J, Wouters E F. COSMIC Study Group . Increased systemic inflammation is a risk factor for COPD exacerbations.  Chest. 2008;  133 350-357
• 21 Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1999;  159 158-164
• 22 Oostenbrink J B, Rutten-van Mölken M P. Resource use and risk factors in high-cost exacerbations of COPD.  Respir Med. 2004;  98 883-891
• 23 Garcia-Aymerich J, Farrero E, Félez M A, Izquierdo J, Marrades R M, Antó J M. Estudi del Factors de Risc d'Agudització de la MPOC investigators . Risk factors of readmission to hospital for a COPD exacerbation: a prospective study.  Thorax. 2003;  58 100-105
• 24 Wong A W, Gan W Q, Burns J, Sin D D, van Eeden S F. Acute exacerbation of chronic obstructive pulmonary disease: influence of social factors in determining length of hospital stay and readmission rates.  Can Respir J. 2008;  15 361-364
• 25 Baker E H, Wood D M, Brennan A L, Clark N, Baines D L, Philips B J. Hyperglycaemia and pulmonary infection.  Proc Nutr Soc. 2006;  65 227-235
• 26 Anderson H R, Spix C, Medina S et al.. Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project.  Eur Respir J. 1997;  10 1064-1071
• 27 Wongsurakiat P, Maranetra K N, Wasi C, Kositanont U, Dejsomritrutai W, Charoenratanakul S. Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: a randomized controlled study.  Chest. 2004;  125 2011-2020
• 28 Jennings J H, Digiovine B, Obeid D, Frank C. The association between depressive symptoms and acute exacerbations of COPD.  Lung. 2009;  187 128-135
• 29 McGhan R, Radcliff T, Fish R, Sutherland E R, Welsh C, Make B. Predictors of rehospitalization and death after a severe exacerbation of COPD.  Chest. 2007;  132 1748-1755
• 30 Abusaid G H, Barbagelata A, Tuero E, Mahmood A, Sharma G. Diastolic dysfunction and COPD exacerbation.  Postgrad Med. 2009;  121 76-81
• 31 Vestbo J, Anderson J A, Calverley P et al.. Adherence to inhaled therapy, mortality, and hospital admission in COPD.  Thorax. 2009;  64 939-943
• 32 Puhan M, Scharplatz M, Troosters T, Walters E H, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2009;  (1) CD005305
• 33 Ko F W, Ip M, Chan P K et al.. A 1-year prospective study of the infectious etiology in patients hospitalized with acute exacerbations of COPD.  Chest. 2007;  131 44-52
• 34 Seemungal T A, Donaldson G C, Paul E A, Bestall J C, Jeffries D J, Wedzicha J A. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  157(5 Pt 1) 1418-1422
• 35 Postma D S, Sluiter H J. Prognosis of chronic obstructive pulmonary disease: the Dutch experience.  Am Rev Respir Dis. 1989;  140(3 Pt 2) S100-S105
• 36 Hodgkin J E. Prognosis in chronic obstructive pulmonary disease.  Clin Chest Med. 1990;  11 555-569
• 37 Wang Q, Bourbeau J. Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD.  Respirology. 2005;  10 334-340
• 38 Atiş S, Kanik A, Ozgür E S, Eker S, Tümkaya M, Ozge C. How exactly can we predict the prognosis of COPD [in Turkish].  Tuberk Toraks. 2009;  57 289-297
• 39 Tsai C L, Camargo Jr C A. The role of body mass index in acute exacerbations of chronic obstructive pulmonary disease.  Emerg Med J. 2009;  26 701-705
• 40 Skyba P, Kluchova Z, Joppa P, Petrasova D, Tkacova R. Nutritional status in relation to respiratory impairment and systemic inflammation in patients with acute exacerbations of COPD.  Med Sci Monit. 2009;  15 CR528-CR533
• 41 Tsimogianni A M, Papiris S A, Stathopoulos G T, Manali E D, Roussos C, Kotanidou A. Predictors of outcome after exacerbation of chronic obstructive pulmonary disease.  J Gen Intern Med. 2009;  24 1043-1048
• 42 ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. American College of Chest Physicians. American Association of Cardiovascular and Pulmonary Rehabilitation . Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines.  Chest. 1997;  112 1363-1396
• 43 Puhan M A, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality — a systematic review.  Respir Res. 2005;  6 54
• 44 Foglio K, Bianchi L, Bruletti G, Battista L, Pagani M, Ambrosino N. Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction.  Eur Respir J. 1999;  13 125-132
• 45 Johnston A K, Mannino D M, Hagan G W, Davis K J, Kiri V A. Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort.  Thorax. 2008;  63 599-605
• 46 Baker E H, Janaway C H, Philips B J et al.. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease.  Thorax. 2006;  61 284-289
• 47 Arbex M A, de Souza Conceição G M, Cendon S P et al.. Urban air pollution and chronic obstructive pulmonary disease-related emergency department visits.  J Epidemiol Community Health. 2009;  63 777-783
• 48 Sunyer J, Antó J M, Murillo C, Saez M. Effects of urban air pollution on emergency room admissions for chronic obstructive pulmonary disease.  Am J Epidemiol. 1991;  134 277-286 discussion 287-289
• 49 Nichol K L, Baken L, Wuorenma J, Nelson A. The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease.  Arch Intern Med. 1999;  159 2437-2442
• 50 Leech J A, Gervais A, Ruben F L. Efficacy of pneumococcal vaccine in severe chronic obstructive pulmonary disease.  CMAJ. 1987;  136 361-365
• 51 Davis A L, Aranda C P, Schiffman G, Christianson L C. Pneumococcal infection and immunologic response to pneumococcal vaccine in chronic obstructive pulmonary disease: a pilot study.  Chest. 1987;  92 204-212
• 52 Steentoft J, Konradsen H B, Hilskov J, Gislason G, Andersen J R. Response to pneumococcal vaccine in chronic obstructive lung disease—the effect of ongoing, systemic steroid treatment.  Vaccine. 2006;  24 1408-1412
• 53 Sumitani M, Tochino Y, Kamimori T, Fujiwara H, Fujikawa T. Additive inoculation of influenza vaccine and 23-valent pneumococcal polysaccharide vaccine to prevent lower respiratory tract infections in chronic respiratory disease patients.  Intern Med. 2008;  47 1189-1197
• 54 Cao Z, Ong K C, Eng P, Tan W C, Ng T P. Frequent hospital readmissions for acute exacerbation of COPD and their associated factors.  Respirology. 2006;  11 188-195
• 55 Ng T P, Niti M, Tan W C, Cao Z, Ong K C, Eng P. Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life.  Arch Intern Med. 2007;  167 60-67
• 56 Laurin C, Labrecque M, Dupuis G, Bacon S L, Cartier A, Lavoie K L. Chronic obstructive pulmonary disease patients with psychiatric disorders are at greater risk of exacerbations.  Psychosom Med. 2009;  71 667-674
• 57 Burrows B, Kettel L J, Niden A H, Rabinowitz M, Diener C F. Patterns of cardiovascular dysfunction in chronic obstructive lung disease.  N Engl J Med. 1972;  286 912-918
• 58 Barberà J A, Peinado V I, Santos S. Pulmonary hypertension in chronic obstructive pulmonary disease.  Eur Respir J. 2003;  21 892-905
• 59 Kessler R, Faller M, Weitzenblum E et al.. “Natural history” of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease.  Am J Respir Crit Care Med. 2001;  164 219-224
• 60 Stockley R A. Progression of chronic obstructive pulmonary disease: impact of inflammation, comorbidities and therapeutic intervention.  Curr Med Res Opin. 2009;  25 1235-1245
• 61 Donaldson G C, Seemungal T A, Patel I S, Lloyd-Owen S J, Wilkinson T M, Wedzicha J A. Longitudinal changes in the nature, severity and frequency of COPD exacerbations.  Eur Respir J. 2003;  22 931-936
• 62 Esteban C, Quintana J M, Moraza J et al.. Impact of hospitalisations for exacerbations of COPD on health-related quality of life.  Respir Med. 2009;  103 1201-1208
• 63 Makris D, Moschandreas J, Damianaki A et al.. Exacerbations and lung function decline in COPD: new insights in current and ex-smokers.  Respir Med. 2007;  101 1305-1312
• 64 Spruit M A, Gosselink R, Troosters T et al.. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I.  Thorax. 2003;  58 752-756
• 65 Lange P. Chronic obstructive pulmonary disease and risk of infection.  Pneumonol Alergol Pol. 2009;  77 284-288
• 66 Zvezdin B, Milutinov S, Kojicic M et al.. A postmortem analysis of major causes of early death in patients hospitalized with COPD exacerbation.  Chest. 2009;  136 376-380
• 67 Brekke P H, Omland T, Smith P, Søyseth V. Underdiagnosis of myocardial infarction in COPD—Cardiac Infarction Injury Score (CIIS) in patients hospitalised for COPD exacerbation.  Respir Med. 2008;  102 1243-1247
• 68 Hanaoka M, Ideura G, Ito M et al.. Pulmonary haemodynamic changes in patients with severe COPD.  Respirology. 2008;  13 919-922
• 69 Weitzenblum E, Chaouat A. Cor pulmonale.  Chron Respir Dis. 2009;  6 177-185
• 70 Soler-Cataluña J J, Martínez-García M A, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease.  Thorax. 2005;  60 925-931
• 71 Fruchter O, Yigla M. Predictors of long-term survival in elderly patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease.  Respirology. 2008;  13 851-855
• 72 Donaldson G C, Seemungal T A, Bhowmik A, Wedzicha J A. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.  Thorax. 2002;  57 847-852
• 73 Eisner M D, Blanc P D, Yelin E H et al.. COPD as a systemic disease: impact on physical functional limitations.  Am J Med. 2008;  121 789-796
• 74 Aimonino N, Tibaldi V, Barale S et al.. Depressive symptoms and quality of life in elderly patients with exacerbation of chronic obstructive pulmonary disease or cardiac heart failure: preliminary data of a randomized controlled trial.  Arch Gerontol Geriatr. 2007;  44(Suppl 1) 7-12
• 75 Cote C G, Dordelly L J, Celli B R. Impact of COPD exacerbations on patient-centered outcomes.  Chest. 2007;  131 696-704
• 76 Kohansal R, Martinez-Camblor P, Agustí A, Buist A S, Mannino D M, Soriano J B. The natural history of chronic airflow obstruction revisited: an analysis of the Framingham offspring cohort.  Am J Respir Crit Care Med. 2009;  180 3-10
• 77 Curkendall S M, Lanes S, de Luise C et al.. Chronic obstructive pulmonary disease severity and cardiovascular outcomes.  Eur J Epidemiol. 2006;  21 803-813