Background: According to the Global Burden of Disease 2018, chronic obstructive pulmonary disease (COPD) is the third-leading cause of death worldwide and in India COPD is the second leading cause of death among noncommunicable diseases. Tools to predict mortality in stable COPD are widely in use but there has been lack of research into exacerbations and finding an appropriate clinical tool could help to reduce morbidity and mortality in these cases. Aims 1. To assess dyspnea, acidosis, consolidation, acidaemia, and atrial fibrillation (DECAF) score and Blood Urea Nitrogen, altered mental status, pulse > 109 beats/min, age > 65 years (BAP- 65) score in acute exacerbations of COPD. 2. To compare the DECAF score and BAP-65 score as predictors of in-hospital morbidity and mortality. Subjects and Methods The study was a prospective observational study carried out on 80 patients with acute exacerbation of COPD admitted to Bangalore Medical College and Research Institute from November 2018 to May 2020. Detailed history, physical examination, and standard laboratory tests were done on admission. Patients were assessed by the DECAF and BAP-65 (blood urea nitrogen, altered mental status, pulse, age ≥65 years) scores. The outcomes in terms of mortality and need for mechanical ventilation were studied and comparisons were drawn between the two scores. Results From 80 AECOPD patients, 8 patients died and 72 survived. Significant difference was found in dyspnea grade eMRCD 5b (P = 0.038), eosinopenia (P = 0.036), pH <7.3 (P < 0.001), and consolidation (P = 0.027) between survivors and patients who died. With the rise in total DECAF score mortality rose (P < 0.001). When the individual components of the BAP-65 score were compared there was no statistically significant difference. With rise in the total BAP-65 score, there was no significant difference in mortality (P = 0.09). Sensitivity for prediction of mortality for DECAF score and BAP-65 score was 88.9% and 81.7%, respectively, and specificity was 55.4% and 63.4% respectively. Sensitivity for prediction of need for mechanical ventilation for DECAF score and BAP-65 score was 83.3% and 83.8%, respectively, and specificity was 66.7% and 66.2%, respectively. Conclusions In our study, we found the DECAF score to be a better predictor of mortality and need for mechanical ventilation than the BAP-65 score as it is a composite score taking into account various parameters such as acidosis, consolidation on imaging, and eosinopenia each of which are individually strong predictors of mortality.
Background: According to the Global Burden of Disease 2018, chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and in India, COPD is the second leading cause of death among noncommunicable diseases. Among India’s 1.31 billion people, about 6% of children and 2% of adults have bronchial asthma. Infective exacerbations of both COPD and Bronchial asthma are common. However, there are some differences in the bacterial spectra between the two conditions, and profiling the bacteria responsible for the exacerbations will help in choosing appropriate antibiotics and also to combat the issue of drug resistance. Aims: (1) To analyze the bacteriological profile of patients with infective exacerbation of COPD and bronchial asthma. (2) To study the outcomes among these patients. Subjects and Methods: The study was a prospective observational study conducted from November 2019 to May 2020 in Bangalore Medical College and Research Institute on 50 patients diagnosed with acute exacerbation of COPD and 50 patients diagnosed with an exacerbation of bronchial asthma. Detailed history, physical examination, and standard laboratory tests were done on admission. Sputum samples were collected from the patients and analyzed by Gram staining and microscopy and also by culture. The differences between the two groups were analyzed. The progression of the disease and the outcomes were observed. Results: 100 patients were included in our study, 50 each in COPD and bronchial asthma. The study was conducted in hospitals attached to BMCRI. Bacteriological profile was assessed by sputum culture and antibiotic sensitivity in the COPD and asthma groups, respectively. In our study, in the COPD group, majority (80%) of patients were males, the mean age was 64.34 ± 9.876, and 80% were smokers with 20% having exposure to biomass. The most common growth in COPD exacerbation was Streptococcus pneumoniae (18%) followed by Haemophilus influenzae and Klebsiella pneumoniae. Mortality in COPD exacerbation was 12%. In the asthma group, female preponderance was seen (54%), mean age was 40.64 ± 13.11. Majority of patients were cases of childhood asthma. Growth was seen in 32% of exacerbations and the most common organism was Streptococcus pneumoniae. Mortality was 4% and importantly due to comorbidities. Conclusions: Bacterial exacerbations are more common in COPD, while it is not so in bronchial asthma. Viral exacerbations and atypical bacterial exacerbations are more common and asthma associated with pneumonia is the cause for culture growth. Mortality is considerably low in the asthma group compared to COPD exacerbations.
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