Risk factors of hospitalization and readmission of patients with COPD exacerbation - Systematic review

Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
International Journal of COPD (Impact Factor: 3.14). 02/2007; 2(3):241-51.
Source: PubMed


Chronic obstructive lung disease (COPD) exacerbations are a significant cause of morbidity and mortality. Data regarding factors which causes or prevents exacerbations is very limited. The aim of this systematic review is to summarize the results from available studies to identify potential risk factors for hospital admission and/or re-admission among patients experiencing COPD exacerbations.
We undertook a systematic review of the literature. Potential studies were identified by searching the electronic databases: PubMed, EMBASE, BIOSIS, CINAHL, PsycINFO, Cochrane library, reference lists in trial reports, and other relevant articles.
Seventeen articles that met the predefined inclusioncriteria were identified. Heterogeneity of study designs, risk factors and outcomes restrict the result to only a systematic review and precluded a formal meta-analysis. In this review, three predictive factors: previous hospital admission, dyspnea and oral corticosteroids were all found to be significant risk factors of readmissions and variables including using long term oxygen therapy, having low health status or poor health related quality of life and not having routine physical activity were all associated with an increased risk of both admission and readmission to hospital.
There are a number of potential modifiable factors that are independently associated with a higher risk of COPD exacerbation requiring admission/readmission to the hospital. Identifying these factors and the development of targeted interventions could potentially reduce the number and severity of such exacerbations.

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    • "Several factors have been previously reported to be associated with increased risk of exacerbation. These include poorer health status [24e27], worsening lung function [23] [28], dyspnea [24], a history of exacerbation [26], and more severe disease [26]. Hurst and colleagues reported a history exacerbation (!1 vs. 0 event) to be the strongest predictor of exacerbations among other significant factors [26]. "
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    ABSTRACT: We evaluated the predictive value of the COPD assessment test (CAT™) for exacerbation in the following six months or time to first exacerbation among COPD patients with previous exacerbations. COPD outpatients with a history of exacerbation from 19 hospitals completed the CAT questionnaire and spirometry over six months. Exacerbation events were prospectively collected using a structured questionnaire. The baseline CAT score categorised into four groups (0–9, 10–19, 20–29, and 30–40) showed strong prediction for time to first exacerbation and modest prediction for any exacerbation or moderate-severe exacerbation (AUC 0.83, 0.64, and 0.63 respectively). In multivariate analyses, the categorised CAT score independently predicted all three outcomes (p=0.001 or p<0.001). Compared with the lowest CAT score category, the higher categories were associated with significantly shorter time to first exacerbation and higher exacerbation risks. The corresponding adjusted median time was >24, 14, 9, and 5 weeks and the adjusted RR was 1.00, 1.30, 1.37, and 1.50 in the category of 0-9, 10-19, 20-29, and 30-40 respectively. Exacerbation history (≥2 vs. 1 event in the past year) was related to time to first exacerbation (adjusted HR 1.35; p=0.023) and any exacerbation during the study period (adjusted RR 1.15; p=0.016). The results of this study support the use of the CAT as a simple tool to assist in the identification of patients at increased risk of exacerbations. This could facilitate timely and cost-effective implementation of preventive interventions, and improve health resource allocation.
    Full-text · Article · Feb 2014 · Respiratory Medicine
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    • "A population-based study found that all levels of regular physical activity were associated with an adjusted lower risk of all-cause mortality and respiratory mortality (Figure 2) [50]. Low levels of physical activity have been associated with a higher risk of hospitalization and re-hospitalization [48,50,51]. In a prospective study in 173 patients with moderate-to-very severe COPD, patients with low physical activity levels (measured objectively) had a shorter time to first COPD admission versus those with higher activity levels [48]. "
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a debilitating disease affecting patients in daily life, both physically and emotionally. Symptoms such as dyspnea and muscle fatigue, lead to exercise intolerance, which, together with behavioral issues, trigger physical inactivity, a key feature of COPD. Physical inactivity is associated with adverse clinical outcomes, including hospitalization and all-cause mortality. Increasing activity levels is crucial for effective management strategies and could lead to improved long-term outcomes. In this review we summarize objective and subjective instruments for evaluating physical activity and focus on interventions such as pulmonary rehabilitation or bronchodilators aimed at increasing activity levels. To date, only limited evidence exists to support the effectiveness of these interventions. We suggest that a multimodal approach comprising pulmonary rehabilitation, pharmacotherapy, and counselling programs aimed at addressing emotional and behavioural aspects of COPD may be an effective way to increase physical activity and improve health status in the long term.
    Full-text · Article · Oct 2013 · Respiratory research
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    • "It is now recognized that the treatment of COPD should involve more than improving lung function since the impact of lung function impairment varies greatly between individual patients. Exacerbations and symptoms also have a significant impact on the health status of these patients.4,23–25 As a result, the GOLD 2011 Strategy Document, updated in 2013, has produced a treatment algorithm based on the assessment of symptoms and exacerbations with the aim of enabling more effective treatment of COPD.5,6 "
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    ABSTRACT: The Global initiative for chronic Obstructive Lung Disease (GOLD) Committee has proposed a chronic obstructive pulmonary disease (COPD) assessment framework focused on symptoms and on exacerbation risk. This study will evaluate a symptom and exacerbation risk-based treatment strategy based on GOLD in a real-world setting in Japan. Optimal management of COPD will be determined by assessing symptoms using the COPD Assessment Test (CAT) and by assessing the frequency of exacerbations. This study ( identifier: NCT01762800) is a 24-week, multicenter, randomized, double-blind, double-dummy, parallel-group study. It aims to recruit 400 patients with moderate-to-severe COPD. Patients will be randomized to receive treatment with either salmeterol/fluticasone propionate (SFC) 50/250 μg twice daily or with tiotropium bromide 18 μg once daily. Optimal management of patients will be assessed at four-weekly intervals and, if patients remain symptomatic, as measured using the CAT, or experience an exacerbation, they have the option to step up to treatment with both drugs, ie, SFC twice daily and tiotropium once daily (TRIPLE therapy). The primary endpoint of the study will be the proportion of patients who are able to remain on the randomized therapy. No data are available. This paper summarizes the methodology of the study in advance of the study starting. The results of this study will help physicians to understand whether TRIPLE therapy is more effective than either treatment strategy alone in controlling symptoms and exacerbations in patients with moderate-to-severe COPD. It will also help physicians to understand the GOLD recommendation work in Japan.
    Full-text · Article · Oct 2013 · International Journal of COPD
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