Lung function and symptom recovery in chronic obstructive pulmonary disease with pneumonic and non-pneumonic exacerbations

Abstract

RATIONALE Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) accelerate decline in lung function and are associated with hospitalization. Patients with COPD are at risk for community acquired pneumonia (CAP). There may be a benefit to distinguish between these entities. OBJECTIVES The objectives of this research were to assess differences in initial presentation and short-term lung function and symptom recovery in patients with COPD hospitalized for AECOPD or CAP. METHODS A single center, non-interventional, prospective cohort study of patients with COPD hospitalized with AECOPD or CAP was used. Baseline characteristics were collected. Spirometry was obtained on admission, at discharge, and 6-wk post-discharge. The primary outcome was change in forced expiratory volume in the first second (FEV1%) predicted over time. COPD Assessment Test (CAT) was used to assess symptom burden on admission and 6-wk post-discharge. MAIN RESULTS A total of 54 patients were recruited, all with at least moderate airflow obstruction. On admission, there were higher levels of CRP in COPD with CAP compared to AECOPD (86.4 [SD 81.9] vs 33.5 [35.4]). There was a statistically significant difference in FEV1% predicted (p = 0.0038) and CAT score (p = 0.0005) over time, after adjusting for presence of CAP. However, there was no difference in FEV1% predicted (p = 0.7184) or CAT score (p = 0.441), between those with an AECOPD and COPD with CAP, after adjusting for time. Average length of stay in hospital was longer in COPD with CAP than for AECOPD (11.0 [10.2] versus 6.9 [4.5] days). CONCLUSIONS Time is the principal factor in short term lung function and symptom recovery in patients with COPD hospitalized for acute respiratory decompensation.