Abstract
Compromised lung function is a common feature of COPD patients, but certain factors increase the rate of lung function decline in COPD patients. The objective of the current study was to investigate the effect of different clinically important factors responsible for rapid deterioration of lung function quantified as ≥ 60 ml decline in FEV1 over a period of one year. COPD patients recruited from the chest clinic of Penang hospital were followed-up for one year from August 2018 to August 2019. Rapid deterioration of lung function was defined as greater than 60 ml/year decline in force expiratory volume in one second. Among 367 included patients 73.84% were male, with mean age 65.26 (9.6) years and % predicted FEV1 51.07 (11.84). 30.27% patients showed mean decline of ≥ 60 ml in FEV1. The regression analysis showed that current smoking relative risk (RR) = 2.38 (1.78–3.07), p < 0.001); GOLD Stage III& IV RR = 1.43 (1.27–1.97), p < 0.001); mMRC score 3 to 4 RR = 2.03 (1.74–2.70), p < 0.01); SGRQ-C score ≥ 10 points difference RR = 2.01 (1.58–2.73), p < 0.01); SGRQ-C symptoms Score ≥ 10 points difference RR = 1.48 (1.23–2.29), p < 0.001); 6MWT < 350 m RR = 2.29 (1.87–3.34), p < 0.01); ≥ 3 exacerbation in study year RR = 2.28 (1.58–2.42, p < 0.001); 8 or more hospital admission days (RR = 3.62 (2.66–4.20), p < 0.001); Charlson comorbidity index ≥ 3 RR = 3.18 (2.23–3.76), p < 0.01) and emphysema RR = 1.31 (1.15–1.79), p < 0.01) were significant risk factors for the rapid deterioration of lung function (FEV1 decline ≥ 60 ml). Among different factors CCI score ≥ 3, abrupt decline in health status, exacerbation frequency ≥ 3, hospital admission days ≥ 8 and emphysema were reported as risk factors for rapid deterioration of lung function.
Highlights
Compromised lung function is a common feature of Chronic obstructive pulmonary disease (COPD) patients, but certain factors increase the rate of lung function decline in COPD patients
Given the discrepancies between and limitations of the studies conducted to date, we investigated the effect of different clinically important factors responsible for rapid deterioration of lung function quantified as ≥ 60 ml decline in FEV1 over a period of one year in a single study
During baseline 175 (47.68%) patients were suffering from moderate COPD (GOLD Stage I&II) and 192 (52.32%) patients were suffering from severe COPD (GOLD Stage III& IV)
Summary
Compromised lung function is a common feature of COPD patients, but certain factors increase the rate of lung function decline in COPD patients. Knowledge about factors responsible for rapid progression of disease can play an important role in disease management decisions and initiation or withdrawal of a therapy This system of prognosis of disease proved its effectiveness in management of community-acquired pneumonia, where implementation of CURB-65 tool in clinical practice resulted in improved patient care[11]. Similar prognostic method in COPD to identify the risk factors responsible for rapid deterioration of lung function, can help to direct resources to the ones in need, reduce progression of disease, reduce exacerbation, improve patient care and reduced burden on healthcare s ystem[12]. Given the discrepancies between and limitations of the studies conducted to date, we investigated the effect of different clinically important factors responsible for rapid deterioration of lung function quantified as ≥ 60 ml decline in FEV1 over a period of one year in a single study. Addition of different potential factors in a multivariate analysis model gives true impact of a factor in presence of different factors
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