Risk factors for exacerbation in chronic obstructive pulmonary disease: a prospective study

• Published in: The international journal of tuberculosis and lung disease 2016-03, Vol.20 (3), p.389-395
• Main Authors: Montserrat-Capdevila, J., Godoy, P., Marsal, J. R., Barbé, F., Galván, L.
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aged, 80 and over; Cohort Studies; COPD; Disease Progression; Dyspnea - epidemiology; Exacerbation; Female; Follow-Up Studies; Forced Expiratory Volume; Hospitalization; Humans; Incidence; Logistic Models; Male; Middle Aged; Mycobacterium; Primary Health Care; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Risk Factors; Smoking - adverse effects
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.15.0441

BACKGROUND: Although acute exacerbations are key events in the progression of chronic obstructive pulmonary disease (COPD), their frequency and the factors associated with acute exacerbation are not fully known.OBJECTIVE: To determine the incidence and risk factors of very frequent exacerbations in COPD (3 per year).PATIENTS AND METHODS: In a cohort study to analyse acute exacerbation and associated factors in 512 primary care patients during a 2-year follow-up, variables of interest were collected for each patient. Acute exacerbation was defined as an event that required antibiotics and/or systemic steroids (moderate) or hospital admission (severe). Odds ratios (OR) were used to determine factors associated with exacerbation.RESULTS: Incidence of exacerbation was 61.7% in the first year of follow-up and 63.9% in the second year. During the first year, the factors associated with very frequent exacerbation were previous hospital admission (OR 1.69), dyspnoea (moderate [OR 2.86] and severe-very severe [OR 5.83]) and the Charlson Index (OR 1.19); during the second year, associated factors were female sex (OR 4.17), history of previous hospital admissions (OR 2.90), smoking (smoker/ex-smoker) (OR 2.00) and forced vital capacity (OR 0.98).CONCLUSIONS: Incidence of exacerbation is high in COPD patients. Previous admission for exacerbation is a strong predictor and can identify patients at risk.