Médecine pulmonaire et respiratoire

Description of Hospital Admissions for Acute Exacerbation of COPD

Abstract

García-Sanz María-Teresa, Cánive-Gómez Juan Carlos, Alonso Acuña Sara, Barreiro García Alejandra, López Val Eva, Senín Rial Laura, Temes Enrique, Álvarez Dobaño José Manuel, Valdés Luis and González-Barcala Francisco-Javier

Background: Chronic obstructive pulmonary disease (COPD) affects 9.1% of the population aged 40-69 in Spain, with wide geographic variation. Acute exacerbations of COPD (AECOPD) are a frequent cause of hospital admission, significantly increasing healthcare costs and affecting the quality of life of patients. Patient characteristics and treatment procedures differ across geographic areas, even across hospitals in the same country.

Objective: To analyze epidemiological and clinical factors associated with hospital admissions for AECOPD in our health area.

Methods: Retrospective study reviewing the medical records of all patients admitted for AECOPD in the Hospital Complex of Santiago de Compostela, between 2007 and 2008. Data are expressed as mean (±standard deviation) or median (interquartile range) values for continuous variables and as frequencies or percentages for categorical variables. Chi-square was used to compare proportions, and Student’s t-test for mean values (Mann-Whitney’s U-test for variables on non-normal distributions).Data analysis was performed with SPSS 15.

Results: We registered 1403 admissions for AECOPD of 757 patients, predominantly male (77% of cases), elderly (60% aged above 75), with moderate to severe forms of the disease, as 56.4% of patients were either in GOLD stage II or III. Smoking history was included in the records of 475 patients (63%), 30% of patients which were active smokers. Charlson index was above 2 in 64% of cases. The most common symptom was dyspnea. Hospital admissions were more common in the winter season. The average stay in the period under study was 12.3 days. 3.6% required admission to the ICU. 6% of patients were readmitted early and 4.8% died during hospitalization. As for baseline therapy, it notably included anticholinergics for 62% and inhaled corticosteroids (ICS) for 60% of patients. 26% followed home oxygen therapy. Smoking cessation care provision took place in 7.9% of cases.

Conclusions: AECOPD patients in our health area are mainly elderly males. Their overall health is not good, with significant comorbidity. The average stay is long. 4.8% die during hospitalization. 5.8% are readmitted within 15 days. 26% follow home oxygen therapy, but this indication is questionable in one in four cases. Smoking cessation care provision during hospitalization should be significantly improved.