Modification of COPD Presentation During the Last 25 Years

Abstract

During the last decades progress has been made in the treatment of Chronic Obstructive Pulmonary Disease (COPD). We compared a random sample of patients admitted for an exacerbation in the period 2001-2005 (n = 101), with a random sample of patients hospitalized for the same reason in the period 1980-1984 (n = 51). Patients of the 2001-2005 cohort had a lower FEV1 (48 ± 3 vs. 41 ± 2% predicted, p = 0.01) for similar mean age, gender and body- mass index when compared to the historical sample. Co-morbidities, according to the Charlson's index, were more prevalent in the 2001-2005 cohort compared to the 1980-1984 cohort, with a reduction of hemoglobin (13.9 ± 0.2 gr/dl vs. 14.9 ± 0.2, p < 0.01) and higher prevalence of anemia in the most recent cohort. We found an increase in the use of cardiovascular drugs and respiratory medications over time with exception for the long-term use of oxygen. Despite lower FEV1 and more prevalent co-morbidities, no difference in length of hospitalization (13.6 ± 1.4 days vs. 12.7 ± 0.7 days, p = 0.52) and 30 months survival post-exacerbation was noted (66.6% vs. 69.3%, p = 0.85). Over the course of 20 years, the presentation of COPD patients admitted for an exacerbation seems to be changed towards a more severe phenotype with lower FEV1 and more co-morbidities. As the length of hospitalization and the overall survival were not different between the two samples, a currently improved management of COPD can be hypothesized.

Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial

“…The low rate of events observed may have different causes, including the improved management of COPD in the latest years. Evidence in support of a more aggressive treatment of both COPD and their comorbidities, leading to hospitalization only of more severe exacerbations has been reported by different studies [26,27]. At any rate, despite the reduced statistical power, our results are in line with other showing that remote arterial oxygen saturation monitoring can reduce hospitalizations in people with very severe COPD [28].…”

Anaemia in chronic obstructive pulmonary disease: an insight into its prevalence and pathophysiology

“…In a retrospective study of a series of patients with various disorders who were discharged from hospital, anaemia prevalence among COPD patients was 23.1 %, comparable with the one among individuals with heart failure [23]. In a longitudinal study by Almagro et al [14], anaemia prevalence among hospitalized patients for AE-COPD was 19.3 %, whereas other authors have reported even higher frequencies, ranging from 26 % to 33 % [15,28]. Hospitalacquired anaemia [29] is a unique entity affecting patients with various disorders who are admitted in hospital; nevertheless, during AECOPD, the burst of systemic inflammation is a factor further inhibiting erythropoiesis, as described below in detail.…”

“…Furthermore, anaemia definition has been variable in published studies. According to current World Health Organization (WHO), anaemia in the general population is defined by Hb levels <13 g/dl in male and <12 g/dl in female [25] and these thresholds have been used by several authors in order to identify anaemic COPD patients [5,8,11,15,26]. However, the use of a Hb <12 g/dl threshold to define anaemia in postmenopausal women is currently under debate [27], so the 13 g/dl threshold for both male and female has also been applied [2,4,7,19].…”

Chronic obstructive pulmonary disease as comorbidity in patients admitted to a university hospital: a cross‐sectional study

“…Danish COPD patients' use of health‐care resources in 2002 came to the amount of 256 million euros, which corresponds to 10% of the total cost of treating patients over 40 years in Denmark . COPD patients are not only in need of treatment for COPD, but also for comorbidities, which are frequent among the patients . COPD also increases the risk of dying from other comorbidities .…”