Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

Abstract

There is little information available concerning the extent to which chronic obstructive pulmonary disease (COPD) patients are satisfactorily managed, especially, regards factors supposedly related to COPD exacerbation. The present study assessed the prevalence rates of potentially modifiable risk factors of COPD exacerbation in patients hospitalized for this reason.A systematic sample of one out of two patients admitted for COPD exacerbation, during 1 yr, in four tertiary hospitals in the Barcelona area, Spain, was performed. Patients answered a questionnaire and underwent anthropometric measurements, spirometric tests and arterial blood gas sampling. Prevalence rates and 95% confidence intervals (95% CI) for risk factors were obtained, and the generalized estimating equation (GEE) method was used to allow for patients to provide information on different admissions.The study recruited 353 patients (29 female) with a total of 404 admissions age (mean SD) 69 9, median forced expiratory volume in one second (FEV1) 31% of predicted and mean partial pressure of oxygen (PO 2 ) 63 13 mmHg. Of these, 28% had not received an influenza vaccination; a high number (86%) did not attend rehabilitation programmes; 28% of patients with PO 2 #55 mmHg were not using long-term oxygen therapy (LTOT); among LTOT users, 18% used it <15 h a day; 43% of the total failed in some of the essential inhaler manoeuvres; 26% were current smokers; 21% of noncurrent smokers were exposed to passive smoking at home; current occupational exposure was low (5%).In summary, the authors found a moderate to high prevalence of potentially modifiable risk factors in a large representative sample of patients hospitalized for a chronic obstructive pulmonary disease exacerbation, suggesting unsatisfactory features in their management. Eur Respir J 2000; 16: 1037±1042. Chronic obstructive pulmonary disease (COPD) is characterized by a chronic slowly progressive limitation of the airflow. As the damage is largely irreversible, the major goals of COPD management are to lessen airflow limitation, prevent and decrease symptoms, prevent and treat medical complications and improve daily living and quality of life [1]. The acute exacerbation of COPD is among the relevant events in the progression of the disease, and its occurrence has been related to the lower survival [2] and decrease in the quality of life [3] of COPD patients. Acute exacerbations are also an important cause of health expenditure, due to hospitalization, outpatient care and drug consumption [1].Although respiratory infection is assumed to be the main risk factor for the exacerbation of COPD [4], other factors are also involved. Health education of patients, smoking cessation, pulmonary rehabilitation, good nutritional status, and early medical intervention are all considered helpful in preventing exacerbations [5]. Information concerning the extent to which COPD patients are satisfactorily managed with regards these factors, although likely to show strong local variations, is relevant ...

COPD: problems in diagnosis and measurement

“…These deficiencies in outpatient management may be addressed to help limit disease exacerbation. In this same study, previous hospital admissions, lower FEV1 and underprescription of long-term oxygen therapy were independently associated with a higher risk of admission for a COPD exacerbation [79]. Longitudinal studies are urgently needed to assess relevant determinants of COPD-related exacerbations and hospitalisation.…”

“…KESSLER et al [78] reported that risk factors for hospitalisation included a low body mass index and poor performance on a 6-min walk test, but gas exchange impairment and pulmonary and haemodynamic dysfunction were the most important risks. Importantly, one study suggests that many patients ultimately hospitalised with COPD exacerbation have modifiable characteristics that impact on susceptibility (such as lack of influenza vaccination, improper use of medications, ongoing cigarette smoke exposure) [79]. These deficiencies in outpatient management may be addressed to help limit disease exacerbation.…”

Predictors of Pharmacotherapy for Tobacco Use Among Veterans Admitted for COPD: The Role of Disparities and Tobacco Control Processes

“…2 Unfortunately, up to one-third of patients admitted to the hospital for a COPD exacerbation continue to smoke. 3,4 Hospitalization is a potentially effective time to provide evidence-based treatment for tobacco cessation. 5 Patients are already in a tobacco-free environment with access to nurses, physicians and pharmacists able to facilitate treatment.…”

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

“…Maintenance medications, including inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics, have been shown to reduce exacerbations and improve lung function and health-related quality of life among patients with moderate to severe disease (5)(6)(7). Nonetheless, use of and adherence to COPD maintenance medications remain low, ranging from 29 to 56%, and contribute to increased hospitalization, health care costs, and mortality (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”