Acute exacerbations of COPD: risk factors for failure and relapse

Mantero, Marco; Rogliani, Paola; Pasquale, Marta Di; Polverino, Eva; Crisafulli, Ernesto; Guerrero, Mónica; Gramegna, Andrea; Cazzola, Mario; Blasi, Francesco

doi:10.2147/copd.s145253

Cited by 43 publications

(48 citation statements)

References 82 publications

(99 reference statements)

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“…Third, the cost-effectiveness should be studied. Fourth, other variables that could have effects on exacerbation of COPD including current smoking status 27 were not evaluated because the HIRA data includes only a limited number of variables. Finally, the management protocol including inhaler training, smoking cessation, and adherence varied according to the institutes.…”

Section: Discussionmentioning

confidence: 99%

Frequent Outpatient Visits Prevent Exacerbation of Chronic Obstructive Pulmonary Disease

Park

Byun

Kim

et al. 2020

Sci Rep

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to April 30, 2015. A definition of COPD was used based on the diagnosis code and medication. Frequent visitors were defined as subjects who visited the outpatient clinic for COPD three or more times per year. Among 159,025 subjects, 117,483 (73.9%) were classified as frequent visitors. Frequent visitors underwent pulmonary function tests and used various inhalers more often than did infrequent visitors. the rates of copD exacerbation requiring admission to a general ward, emergency room, or intensive care unit were significantly lower in frequent visitors than in infrequent visitors. In multivariable analysis, frequent visits were identified as an independent factor preventing COPD exacerbation that required admission to a ward (odds ratio [OR], 0.387), emergency room, (OR, 0.558), or intensive care unit (OR, 0.39) (all P < 0.001). In conclusion, we showed frequent outpatient visits reduce the risk of COPD exacerbation by 45-60%.Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the airways that requires lifelong management 1 . A report from the Global Initiative for Chronic Obstructive Lung Disease have described routine patient follow-up as essential 2 . Lung function may worsen over time because of the natural history of COPD, so regular visits are needed to ensure frequent pulmonary function tests 3 . Symptoms and history of exacerbations should be monitored at these visits to adjust treatment, identify complications or comorbidities, and prevent acute exacerbations 4,5 . Frequent outpatient visits also offer patients an opportunity to improve their skills using inhalers, increase their knowledge of rehabilitation and nutritional support, and receive vaccination, all of which improve the clinical outcomes of COPD 6-9 . However, although there is good reason to believe that frequent outpatient visits have a prognostic benefit in COPD, there is insufficient scientific evidence to support this assumption.Until now, whether or not frequent outpatient visits have a prognostic benefit in COPD and how often patients should visit a hospital outpatient clinic to prevent exacerbations has never been investigated. The aim of this study was to determine whether or not frequent outpatient visits reduce the risk of exacerbation of COPD using data from a Korean national cohort study.

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Section: Discussionmentioning

confidence: 99%

Frequent Outpatient Visits Prevent Exacerbation of Chronic Obstructive Pulmonary Disease

Park

Byun

Kim

et al. 2020

Sci Rep

View full text Add to dashboard Cite

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“…This finding was also demonstrated in other studies [7,8] and, in fact, was included in several validated predictive indices such as the PEARL, BODEX, or CODEX indices, among others [33]. Although it could be considered more of a consequence than a cause, its independent predictive capacity leads us to believe that some patients may have a COPD with a particularly strong demand for hospital management, added to the current limitations of the definition of severe exacerbation and the hospitalization criteria, which are not exempt from a certain degree of subjectivity and vary greatly among hospitals [6,9].…”

Section: Discussionmentioning

confidence: 99%

“…This condition is characterized by its chronicity and frequent acute exacerbations that contribute to a significant deterioration of the patients' health, affect the disease's progression and control, and result in a strong demand for health care resources, with the consequent socioeconomic impact, which accounts for 60%-70% of the costs of this disease [1][2][3]. An additional problem associated with this condition is that a significant number of patients admitted to the hospital for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) will be readmitted in the following weeks or months, as demonstrated in many studies reporting readmission rates of 20%, 35%, and 60% at 30, 90, and 365 days, respectively [3][4][5][6][7][8][9][10]. The detection of factors that may allow us to predict these events has been the subject of multiple research studies carried out in recent years, as this would allow us to stratify the risks more accurately and apply interventions aimed at the most vulnerable groups of patients [3][4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Although the available literature is very heterogeneous, the most frequently described predictive variables can be categorized as those related to the patient (previous admissions, severity of the condition, need for oxygen therapy or at-home ventilation, older age, low quality of life, comorbidities, low socioeconomic level, low therapeutic adherence, or active smoking) and those related to the health system (duration of previous hospital admissions, absence of a defined follow-up program, or poor health education) [3][4][5][6][7][8][9][10][11][12][13]. Although some studies have reported that the patients' deficient social situation are predictive factors for readmission and mortality, the analyses carried out to date have been very scarce and solely based on data regarding the patients' level of education, economic income, or the characteristics of the patients' home or caregivers and which have not been collected systematically [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, most studies have only analysed these factors at 30 or 90 days of hospital discharge, and the long-term evidence is much more limited, with no references on whether these predictive factors vary over time until the patients' readmission [4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd

et al. 2020

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Introduction and objectives The aim of this study was to evaluate the predictive ability of multiple social, and clinical factors for readmission after a severe acute exacerbation of COPD (AECOPD) during various time periods. Methods We performed a prospective cohort study in which recruited patients with AECOPD. We systematically collected numerous clinical (symptoms, pulmonary function, comorbidities, and treatment) and social (financial situation, housing situation, family support, caregiver overload, ability to perform activities, and risk of social exclusion) variables using several questionnaires and indices. The patients were followed closely for one year and readmissions at 30, 60, and 365 days were analysed. Results 253 patients were included, aged 68.9±9.8years, FEV 1 = 42.1%±14.2%, and a Charlson's index = 1.8±0.9. Of these patients, 20.2%, 39.6%, and 63.7% were readmitted within the first 30, 90, and 365 days after discharge, respectively. In the multivariate model applied, the variables that were independently associated with readmission over all three periods of the analysis were dependence to perform basic activities of daily living (BADLs) (odds ratio [OR] = 2.10-4.10) and a history of two or more admissions within the previous year (OR = 2.78-3.78). At 90 days, a history of bacterial isolates in a previous sputum culture (OR = 2.39) and at 365 days, a high grade of dyspnoea (OR = 2.51) and obesity (OR = 2.38) were also identified as predictors of hospital readmission.

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Circulating JNK pathway‐associated phosphatase: A novel biomarker correlates with Th17 cells, acute exacerbation risk, and severity in chronic obstructive pulmonary disease patients

Gao

Feng

et al. 2021

Clinical Laboratory Analysis

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Background JNK pathway‐associated phosphatase (JKAP) involves in the regulation of inflammation, immunity, and lung injury. The current study aimed to investigate correlation of JKAP with Th1, Th17 cells, acute exacerbation risk, and disease severity in chronic obstructive pulmonary disease (COPD) patients. Methods Totally, 45 stable COPD (SCOPD) patients, 45 acute exacerbation COPD (AECOPD) patients, and 45 controls were enrolled. Serum was collected for JKAP, interferon‐gamma (IFN‐γ) (Th1 cytokine), and interleukin 17 (IL‐17) (Th17 cytokine) detection. Besides, peripheral blood mononuclear cell from COPD patients was collected for evaluating Th1 and Th17 cells. Results JKAP was highest in controls followed by SCOPD patients and lowest in AECOPD patients (median: 105.673 vs. 75.374 vs. 41.807 pg/ml, p < 0.001). Meanwhile, receiver operating characteristic (ROC) curves revealed that JKAP differentiated the AECOPD patients from the controls (area under curve (AUC): 0.910 (95% confidence interval (CI): 0.849–0.970)) and AECOPD patients from SCOPD patients (AUC: 0.726 (95% CI: 0.622–0.830)). Moreover, JKAP positively correlated with FEV1 (%predicted) in AECOPD patients (r = 0.347 p = 0.019). Additionally, JKAP was negatively correlated with the GOLD stage in AECOPD patients (r = −0.344, p = 0.021) and SCOPD patients (r = −0.357, p = 0.016). Whereas, JKAP was not associated with other clinical features (all p > 0.05). Besides, JKAP was negatively linked with Th17 cells (r = −0.378, p = 0.010), IFN‐γ (r = −0.358, p = 0.016), IL‐17 (r = −0.414, p = 0.005) in AECOPD patients and Th17 cells (r = −0.342, p = 0.022), IL‐17 (r = −0.299, p = 0.046) in SCOPD patients. Conclusion Downregulated JKAP correlates with Th17 cells, higher acute exacerbation risk, and severity in COPD patients, indicating its underlying potency as a biomarker for COPD.

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Acute exacerbations of COPD: risk factors for failure and relapse

Cited by 43 publications

References 82 publications

Frequent Outpatient Visits Prevent Exacerbation of Chronic Obstructive Pulmonary Disease

Frequent Outpatient Visits Prevent Exacerbation of Chronic Obstructive Pulmonary Disease

Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd

Circulating JNK pathway‐associated phosphatase: A novel biomarker correlates with Th17 cells, acute exacerbation risk, and severity in chronic obstructive pulmonary disease patients

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