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Abstract
Patients with chronic obstructive pulmonary disease (COPD) often present with severe
acute exacerbations requiring hospital treatment. However, little is known about the
prognostic consequences of these exacerbations. A study was undertaken to investigate
whether severe acute exacerbations of COPD exert a direct effect on mortality.
Multivariate techniques were used to analyse the prognostic influence of acute exacerbations
of COPD treated in hospital (visits to the emergency service and admissions), patient
age, smoking, body mass index, co-morbidity, long term oxygen therapy, forced spirometric
parameters, and arterial blood gas tensions in a prospective cohort of 304 men with
COPD followed up for 5 years. The mean (SD) age of the patients was 71 (9) years and
forced expiratory volume in 1 second was 46 (17)%.
Only older age (hazard ratio (HR) 5.28, 95% CI 1.75 to 15.93), arterial carbon dioxide
tension (HR 1.07, 95% CI 1.02 to 1.12), and acute exacerbations of COPD were found
to be independent indicators of a poor prognosis. The patients with the greatest mortality
risk were those with three or more acute COPD exacerbations (HR 4.13, 95% CI 1.80
to 9.41).
This study shows for the first time that severe acute exacerbations of COPD have an
independent negative impact on patient prognosis. Mortality increases with the frequency
of severe exacerbations, particularly if these require admission to hospital.