Factors associated with exacerbation in mild- to-moderate COPD patients

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Introduction

COPD exacerbation negatively impacts the patient’s quality of life and lung function, increases mortality, and increases socioeconomic costs. In a real-world setting, the majority of patients with COPD have mild-to-moderate airflow limitation. Therefore, it is important to evaluate COPD exacerbation in patients with mild-to-moderate airflow limitation, although most studies have focused on the patients with moderate or severe COPD. The objective of this study was to evaluate factors associated with COPD exacerbation in patients with mild-to-moderate airflow limitation.

Methods

Patients registered in the Korean COPD Subtype Study cohort were recruited from 37 tertiary referral hospitals in Korea. We obtained their clinical data including demographic characteristics, past medical history, and comorbidities from medical records. Patients were required to visit the hospital to document their COPD status using self-administered questionnaires every 6 months.

Results

A total of 570 patients with mild-to-moderate airflow limitation were enrolled. During the first year of follow-up, 30.5% patients experienced acute exacerbation, with exacerbations being more common in patients with poor lung function. Assessed factors associated with COPD exacerbation included COPD assessment test scores, modified Medical Research Council dyspnea assessment test scores, St George’s Respiratory Questionnaire for COPD scores, a previous history of exacerbation, and histories of pneumonia and allergic rhinitis. Logistic regression tests revealed St George’s Respiratory Questionnaire for COPD scores (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.04; P=0.034), a previous history of exacerbation (OR, 3.12; 95% CI, 1.35–7.23; P=0.008), and a history of pneumonia (OR, 1.85; 95% CI, 1.06–3.25; P=0.032) as risk factors for COPD exacerbation.

Conclusion

Our results suggest that COPD exacerbation in patients with mild-to-moderate airflow limitation is associated with the patient’s quality of life, previous history of exacerbation, and history of pneumonia.

Related collections

Most cited references 13

Record: found
Abstract: found
Article: not found

St. George's Respiratory Questionnaire: MCID.

Jace W. Jones, Yeon-Mok Oh (2005)

The SGRQ is a disease-specific measure of health status for use in COPD. A number of methods have been used for estimating its minimum clinically important difference (MCID). These include both expert and patient preference-based estimates. Anchor-based methods have also been used. The calculated MCID from those studies was consistently around 4 units, regardless of assessment method. By contrast, the MCID calculated using distribution-based methods varied across studies and permitted no consistent estimate. All measurements of clinical significance contain sample and measurement error. They also require value judgements, if not about the calculation of the MCID itself then about the anchors used to estimate it. Under these circumstances, greater weight should be placed upon the overall body of evidence for an MCID, rather than one single method. For that reason, estimates of MCID should be used as indicative values. Methods of analysing clinical trial results should reflect this, and use appropriate statistical tests for comparison with the MCID. Treatments for COPD that produced an improvement in SGRQ of the order of 4 units in clinical trials have subsequently found wide acceptance once in clinical practice, so it seems reasonable to expect any new treatment proposed for COPD to produce an advantage over placebo that is not significantly inferior to a 4-unit difference.

0 comments Cited 120 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The economic burden of COPD.

Sean D Sullivan, Scott Ramsey, Todd Lee (2000)

COPD is one of the leading causes of morbidity and mortality worldwide and imparts a substantial economic burden on individuals and society. Despite the intense interest in COPD among clinicians and researchers, there is a paucity of data on health-care utilization, costs, and social burden in this population. The total economic costs of COPD morbidity and mortality in the United States were estimated at $23.9 billion in 1993. Direct treatments for COPD-related illness accounted for $14.7 billion, and the remaining $9.2 billion were indirect morbidity and premature mortality estimated as lost future earnings. Similar data from another US study suggest that 10% of persons with COPD account for > 70% of all medical care costs. International studies of trends in COPD-related hospitalization indicate that although the average length of stay has decreased since 1972, admissions per 1,000 persons per year for COPD have increased in all age groups > 45 years of age. These trends reflect population aging, smoking patterns, institutional factors, and treatment practices.

0 comments Cited 109 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease.

I Osman, Fiona S. Legge, Michael Douglas … (1996)

There is some evidence that quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD) may predict clinical outcomes and use of resources. This study examined whether QOL scores could prospectively predict re-admission for COPD or death within 12 months of an original admission, and whether QOL scores predicted home nebuliser provision. The study was carried out in all acute medical wards of Aberdeen Royal Infirmary, Woodend and City Hospitals, Aberdeen over 12 months. A total of 377 patients admitted with an exacerbation of COPD were identified in this time, 111 of whom were not included in the study because they refused the interview or died before discharge. The remaining 266 patients completed the St George's Respiratory Questionnaire (SGRQ). Information on spirometric parameters, nebuliser provision at discharge, provision of domiciliary oxygen, and re-admission within 12 months was collected from patient notes. The mean age of the patients was 68 years and 53% were men. The mean (SD) forced expiratory volume in one second (FEV1) was 38.8 (18.0)% predicted and forced vital capacity (FVC) was 58.9 (23.8)% predicted. Higher (worse) scores on the SGRQ were significantly related to re-admission for COPD in the next 12 months (difference = 4.8, 95% CI 1.6 to 8.0). Patients who were re-admitted and died from COPD did not differ in SGRQ scores from those who were re-admitted and survived for more than 12 months. Re-admission was not related to sex, age, or pulmonary function. One hundred and thirty eight patients did not have a home nebuliser before admission. Of these, 14 were provided with a home nebuliser at discharge. Patients provided with nebulisers had significantly worse SGRQ scores and worse FVC. The 41 patients given domiciliary oxygen did not differ in SGRQ or spirometric parameters. Logistic regression analysis of the three SGRQ subscales (Symptom, Impact and Activity), adjusting for lung function, age and sex, showed that all three subscales were significantly related to hospital readmission and that Impact scores were related to nebuliser provision. Women did not differ from men in Symptom scores on the SGRQ but differed markedly on the Activity and Impact scales. It is concluded that poor scores on the SGRQ, a QOL scale which measures patient distress and coping, are associated with re-admission for COPD and use of resources such as nebulisers, independent of physiological measures of disease severity.

0 comments Cited 32 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): International Journal of COPD

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove Medical Press

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date Collection: 2016

Publication date (Electronic): 16 June 2016

Volume: 11

Pages: 1327-1333

Affiliations

[1 ]Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea

[2 ]Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University, Bucheon, Republic of Korea

[3 ]Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea

[4 ]Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea

[5 ]Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea

[6 ]Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Republic of Korea

Author notes

Correspondence: Yong Il Hwang, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Pyeongan-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea, Tel +82 31 380 3715, Fax +82 31 380 3973, Email hyicyk@ 123456hallym.or.kr

Article

Publisher ID: copd-11-1327

DOI: 10.2147/COPD.S105583

PMC ID: 4914068

PubMed ID: 27366060

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Factors associated with exacerbation in mild- to-moderate COPD patients

Read this article at

Abstract

Introduction

Methods

Results

Conclusion

Related collections

International Journal of COPD

Most cited references 13

St. George's Respiratory Questionnaire: MCID.

The economic burden of COPD.

Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease.

Author and article information

Journal

Affiliations

Author notes

Article

Categories

Comments

Comment on this article

Similar content 703

Cited by 5

Most referenced authors 574