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Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease
  1. J J Soler-Cataluña1,
  2. M Á Martínez-García1,
  3. P Román Sánchez2,
  4. E Salcedo2,
  5. M Navarro2,
  6. R Ochando3
  1. 1Hospital General de Requena, Unidad de Neumología, Servicio de Medicina Interna, Requena (Valencia), Spain
  2. 2Hospital General de Requena, Servicio de Medicina Interna, Requena (Valencia), Spain
  3. 3Hospital General de Requena, Servicio de Urgencias, Requena (Valencia), Spain
  1. Correspondence to:
    Dr J J Soler-Cataluña
    Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Paraje Casablanca s/n 46340, Requena (Valencia), Spain; jjsolertelefonica.net

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.

  • BMI, body mass index
  • COPD, chronic obstructive pulmonary disease
  • FEV1, forced expiratory volume in 1 second
  • FVC, forced vital capacity
  • LTOT, long term oxygen therapy
  • Pao2, Paco2, arterial oxygen and carbon dioxide tensions
  • chronic obstructive pulmonary disease
  • exacerbations
  • hospitalisation
  • mortality
  • prognostic value
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Footnotes

  • Competing interests : none declared

  • Published Online First 29 July 2005

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