Managing patients with COPD exacerbation: does age matter?

Stone, Robert; Lowe, Derek; Potter, Jonathan; Buckingham, Rhona; Roberts, C M; Pursey, Nancy J.

doi:10.1093/ageing/afs039

Cited by 29 publications

(24 citation statements)

References 7 publications

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“… 20 Stone et al showed older people admitted with AECOPD had more severe symptoms and comorbidity prior to exacerbation and higher in-patient/90-day mortality following exacerbation. 21 In our study, every ten years of age increased the risk of re-exacerbation in 90 days after discharge from hospital (OR =1.359). Therefore, age category was selected as a parameter of the re-AE INDEX, which increased the sensitivity and specificity of the predictive power compared with that without age category (data not shown).…”

Section: Discussionsupporting

confidence: 44%

Prediction of short term re-exacerbation in patients with acute exacerbation of chronic obstructive pulmonary disease

Liu¹,

Peng²,

Zhang³

et al. 2015

COPD

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BackgroundThe objective of the study is to develop a scoring system for predicting a 90-day re-exacerbation in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).MethodsA total of 176 consecutive hospitalized patients with AECOPD were included. The sociodemographic characteristics, status before acute exacerbation (AE), presentations of and treatment for the current AE, and the re-exacerbation in 90 days after discharge from hospital were collected.ResultsThe re-exacerbation rate in 90 days was 48.9% (86 out of 176). It was associated with the degree of lung function impairment (Global initiative for chronic Obstructive Lung Disease [GOLD] grades), frequency of AE in the previous year, and parameters of the current AE, including pleural effusion, use of accessory respiratory muscles, inhaled long-acting β-2-agonists, inhaled corticosteroids, controlled oxygen therapy, noninvasive mechanical ventilation, and length of hospital stay, but was not associated with body mass index, modified Medical Research Council scale, or chronic obstructive pulmonary disease assessment test. A subgroup of ten variables was selected and developed into the re-exacerbation index scoring system (age grades, GOLD grades, AE times in the previous year, pleural effusion, use of accessory respiratory muscles, noninvasive mechanical ventilation, controlled oxygen therapy, inhaled long-acting β-2-agonists and inhaled corticosteroids, and length of hospital stay). The re-exacerbation index showed good discrimination for re-exacerbation, with a C-statistic of 0.750 (P<0.001).ConclusionA comprehensive assessment integrating parameters of stable chronic obstructive pulmonary disease, clinical presentations at exacerbation, and treatment showed a strong predictive capacity for short-term outcome in patients with AECOPD. Further studies are required to verify these findings.

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Section: Discussionsupporting

confidence: 44%

Prediction of short term re-exacerbation in patients with acute exacerbation of chronic obstructive pulmonary disease

Liu¹,

Peng²,

Zhang³

et al. 2015

COPD

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“…In other studies, age was an independent predictor of mortality during one-year of follow-up after hospitalization for an eCOPD [ 14 , 15 ]. It must be noted, however, that age is a stronger predictor of long-term mortality following eCOPD hospitalization than it is as a predictor for in-hospital mortality [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of one-year mortality after hospitalization for an exacerbation of COPD

et al. 2018

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BackgroundHospitalization for a severe exacerbation of COPD (eCOPD) is an important event in the natural history of COPD. Identifying factors related to mortality 1 year after hospitalization could help determine interventions to reduce mortality.MethodsIn a prospective, observational, multicentre study, we evaluated data from two cohorts: the Spanish audit of hospital COPD exacerbation care (our derivation sample) and the Spanish cohort of the European audit of COPD exacerbation care (our validation sample). The endpoint was all-cause mortality. Mortality was determined by local research managers of the participating hospitals and matched the official national index records in Spain.ResultsIn the multivariate analysis, factors independently related to an increase in mortality were older age, cardio-cerebro-vascular and/or dementia comorbidities, PaCO2 > 55 mmHg measured at emergency department arrival, hospitalizations for COPD exacerbations in the previous year, and hospital characteristics. The area under the receiver-operating curve for this model was 0.75 in the derivation cohort and 0.76 in the validation cohort.ConclusionOne-year mortality following the index hospitalization for an exacerbation of COPD was related to clinical characteristics of the patient and of the index event, previous events of similar severity, and characteristics of the hospital where the patient was treated.

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“…In patients with high occurrence of exacerbations (especially if post-BD FEV 1 ≤60% of the predicted value) it is advisable to include a combination of LABA and inhaled corticosteroid (ICS) in the therapy 3,47,59,60,79 . Evidence for the effectiveness of LAMA + ICS is still lacking.…”

Section: Additional Components Of the Standard Treatmentmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease: Official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care

Koblížek

Chlumský²,

Zindr³

et al. 2013

BIOMED PAP

125

116

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Managing patients with COPD exacerbation: does age matter?

Abstract: clinicians should consider increasing age as a specific risk factor in the management of COPD. Acute units and community teams should review carefully their protocols and pathways for how they assess, manage, discharge and follow-up older patients with COPD exacerbation.

Cited by 29 publications

References 7 publications

Prediction of short term re-exacerbation in patients with acute exacerbation of chronic obstructive pulmonary disease

Prediction of short term re-exacerbation in patients with acute exacerbation of chronic obstructive pulmonary disease

Predictors of one-year mortality after hospitalization for an exacerbation of COPD

Chronic Obstructive Pulmonary Disease: Official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care

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