Risk of exacerbation in chronic obstructive pulmonary disease: a primary care retrospective cohort study

Abstract

BackgroundThe risk of exacerbation in chronic obstructive pulmonary disease (COPD) depends on the severity of disease and other less well known factors. Predictive models of exacerbation are more accurate than the forced expiratory volume in one second (FEV1). The objective was to design a model that predicts the risk of exacerbation in COPD.MethodsRetrospective cohort study with data from the electronic medical records of patients diagnosed with COPD in the province of Lleida (Spain). A total of 2501 patients were followed during 3 years. The dependent variable was acute exacerbation; independent variables were: clinical parameters, spirometry results, severity of disease, influenza and 23-valent pneumococcal immunisation, comorbidities, smoking and history of exacerbation. The association of these variables with disease exacerbation was measured by the adjusted odds ratio using a logistic regression model.ResultsMean age at the start of the study was 68.38 years (SD = 11.60) and 74.97 % patients were men; severity of disease was considered mild in 50.82 % of patients, moderate in 35.31 %, severe in 9.44 % and very severe in 4.44 %. During the three year study period up to 83.17 % of patients experienced at least one exacerbation. Predictive factors in the model were age, gender, previous exacerbations, influenza and 23-valent pneumococcal immunisations, number of previous visits to the General Practice and severity (GOLD), with an area under the ROC curve (AUROC) of 0.70.ConclusionsThis model can identify patients at high risk of acute exacerbation. Preventive measures and modification of treatment in these high-risk patients would improve survival.

Lung ageing and COPD: is there a role for ageing in abnormal tissue repair?

“…The frequent exacerbator is an interesting phenotype, as exacerbations are in general linked to infections and the susceptibility for infections increases with age [70,71]. Moreover, age is a risk factor for COPD exacerbations [72] and hospital admissions for acute exacerbations of COPD [73].…”

Risk factors of chronic obstructive pulmonary disease exacerbations

“…A Spanish study that included 2501 patients over a 3‐year period, showed that older patients had at least one episode of exacerbation during the follow‐up period. In their study an over 68 age was the second predictor factor of future risk of exacerbations in the history of exacerbations …”

“…Several studies showed that older age and low body mass index (BMI) were associated with higher rate of acute exacerbation episodes . A large study carried out in Scotland, which included 3342 patients with COPD that had been followed for a long period of time (median 1.9 years) showed that the increasing age and a low BMI were associated with poor outcome .…”

“…Several studies showed that older age and low body mass index (BMI) were associated with higher rate of acute exacerbation episodes. [138][139][140][141] A large study carried out in Scotland, which included 3342 patients with COPD that had been followed for a long period of time (median 1.9 years) showed that the increasing age and a low BMI were associated with poor outcome. 139 A retrospective study conducted by Hunter et al 138 showed that older age patients and patients with low BMI presented an increased risk of first AECOPD admission after diagnosis.…”

Factors associated with the rate of COPD exacerbations that require hospitalization

“…Several studies have shown the association of a range of variables with frequency of different COPD exacerbations (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”