Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Rural Area: Why, How, and What Next?

Abstract

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to fall in lung function, quality of life, and ultimately disease progression. The present study is an effort to study in detail about COPD exacerbation in a rural tertiary hospital. Aim: To study demographic, clinical, and laboratory profile of hospitalized patients of AECOPD. Methodology: Retrospective data of 170 consecutive patients of AECOPD were collected from records, were divided into two groups based on severity, and were analyzed: Group 1 for admission in the wards and Group 2 for intensive care unit (ICU) admissions. Results: A total of 141 (82.9%) patients were hospitalized in the wards, whereas 29 (17.1%) were admitted in the ICU. The mean age was 62.36 years in the wards and 64.89 years in the ICU. Nearly 89.4% of patients were smokers. Dyspnea (100%) was the most common symptom followed by cough (99%) and expectoration (98%). The mean respiratory rate at the time of presentation was 26/min in the wards and 31.56/min in the ICU. The mean oxygen saturation was 93% in the wards and 88.62% in the ICU. The mean post forced expiratory volume in 1 s (FEV1) was 43.98% in ward patients and 29.28% among ICU patients. Arterial blood gas revealed mean PaCO2 of 44.25 mmHg in the wards and 63.24 mmHg in the ICU. The mean pH in the ward was 7.48 compared to 7.34 in the ICU. The mean pulmonary arterial pressure (PAP) was higher in the ICU (53.74 mmHg) than in the ward (38.87 mmHg). Conclusion: The ratio of hospitalization in ICU to ward was 1:5. The site of treatment depends on respiratory rate, oxygen saturation, post-FEV1%, PAP, pH, and PaCO2.