Investigation of Relationship between Comorbid Factors and Excessive Dynamic Airway Collapse and Frequency of Hospitalization in Frequently Hospitalized COPD Patients

Abstract

Objective: "Frequent hospitalization" is defined as at least 2 hospitalizations per year in chronic obstructive pulmonary disease (COPD). However, we witness hospitalizations at 2-3-month intervals in some patients in our clinical practice. In our study, the factors considered to be associated with frequent hospitalizations were investigated in a selected patient group.Methods: Thirty-four COPD patients being hospitalized at least twice per year were included in the study. The patients' demographic features, laboratory findings, physical activity scores, comorbidities, and respiratory functions were recorded. They underwent transthoracic echocardiography and fiberoptic bronchoscopy (FOB). The patients were categorized as Group 1 (patients hospitalized twice per year) and Group 2 (patients hospitalized more than twice per year). These groups were compared with regard to parameters considered to increase the frequency of hospitalization.Results: Twenty-eight (82%) of the patients were male. The mean age was 65±8 (46-82) years, and the mean hospitalization number was 3.3±1.3 (2-6). There were 12 patients in Group 1 and 22 patients in Group 2. The rates of being in advanced age, showing lower physical activity, being in advanced stage, having disease for more than 10 years, and using a nebulizer and oxygen at home were found to be significantly higher in Group 2 than in Group 1. FEV 1 (expected %) level was 47.9% in Group 2, while it was 56% in Group 1 (p=0.003). The number of comorbidities was approximately 1.5 in Group 1 and 2.7 in Group 2 (p=0.014). Pulmonary hypertension (n=11) and heart failure (n=10) were identified only in Group 2 (p=0.003, p=0.006). Excessive dynamic airway collapse (EDAC) was detected in 17 (50%) patients through FOB, and 16 of them were in Group 2. Logistic regression analysis revealed the existence of EDAC and a low level of FEV 1 (expected %) as the independent factors that affected the number of hospitalizations. Conclusion:It was suggested that the existence of EDAC and decreased FEV 1 can increase the frequency of hospitalization in COPD patients who are hospitalized frequently.