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      Risk factors for respiratory hospitalizations in a population of patients with a clinical diagnosis of COPD

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          Abstract

          Purpose

          The purpose of this study was to examine differences between patients clinically diagnosed with COPD with and without obstruction by spirometry and to identify risk factors for respiratory hospitalizations.

          Materials and methods

          This is a retrospective analysis of all patients diagnosed with COPD at a large academic Internal Medicine Clinic in 2014, who had spirometry performed during the period 2013–2014. Two groups existed: one with obstruction termed classical COPD and another without obstruction. Demographics, comorbidities, prescribed medications, spirometry, respiratory hospitalization, and eosinophilia among other variables were compared between patients with and without obstruction. Risk factors for two or more respiratory hospitalizations during the period 2014–2015 were sought for both populations by both univariate and multivariate analyses. Subsequently, we studied the population without obstruction for risk factors for one or more respiratory hospitalizations first by univariate analysis and then by multivariate analysis.

          Results

          Among 657 patients, 210 met inclusion criteria, with 157 having obstruction on spirometry and 53 without obstruction. There was no difference between those with and without obstruction on the rate of respiratory hospitalization when using two or more respiratory hospitalizations ( p=0.397) or one or more respiratory hospitalizations ( p=0.467). Nontreatment risk factors associated with two or more respiratory hospitalizations by multivariate analysis included a maximum eosinophil count above the threshold of 0.5 K/µL (maximum eosinophil number threshold [MENT]; p=0.001, OR =3.792, 95% CI =1.676–8.582) and % predicted forced expiratory volume in the first second ( p=0.031, OR =0.978, 95% CI =0.959–0.998). In patients without obstruction, MENT above the threshold of 0.5 K/µL ( p=0.032, OR =5.087, 95% CI =1.147–22.557) was the only risk factor associated with one or more respiratory hospitalizations.

          Conclusion

          In a clinically diagnosed COPD population who had spirometry performed, the presence of airflow obstruction was not a risk factor for respiratory hospitalizations. The most significantly associated nontreatment factor associated with respiratory hospitalization, both in the study population as a whole and in the cohort without obstruction, was MENT above the threshold of 0.5 K/µL.

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          Most cited references 13

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          Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

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              Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function.

              Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2018
                28 March 2018
                : 13
                : 1061-1069
                Affiliations
                [1 ]Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
                [2 ]Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
                Author notes
                Correspondence: Daniel R Ouellette, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, K-17, 2799 West Grand Blvd., Detroit, MI 48202, USA, Tel +1 313 916 2439, Fax +1 313 916 9102, Email douelle1@ 123456hfhs.org
                Article
                copd-13-1061
                10.2147/COPD.S157230
                5881524
                © 2018 Veljanovski and Ouellette. This work is published and licensed by Dove Medical Press Limited

                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.

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                Original Research

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