Risk of exacerbation in chronic obstructive pulmonary disease: a primary care retrospective cohort study.

Josep Montserrat-Capdevila,Josep Ramon Marsal,Josep Ramon Marsal,Pere Godoy,Pere Godoy,Josep Ramon Marsal,Leonardo Galván,Ferran Barbé

doi:10.1186/s12875-015-0387-6

Abstract

BackgroundThe risk of exacerbation in chronic obstructive pulmonary disease (COPD) depends on the severity of disease and other less well known factors. Predictive models of exacerbation are more accurate than the forced expiratory volume in one second (FEV1). The objective was to design a model that predicts the risk of exacerbation in COPD.MethodsRetrospective cohort study with data from the electronic medical records of patients diagnosed with COPD in the province of Lleida (Spain). A total of 2501 patients were followed during 3 years. The dependent variable was acute exacerbation; independent variables were: clinical parameters, spirometry results, severity of disease, influenza and 23-valent pneumococcal immunisation, comorbidities, smoking and history of exacerbation. The association of these variables with disease exacerbation was measured by the adjusted odds ratio using a logistic regression model.ResultsMean age at the start of the study was 68.38 years (SD = 11.60) and 74.97 % patients were men; severity of disease was considered mild in 50.82 % of patients, moderate in 35.31 %, severe in 9.44 % and very severe in 4.44 %. During the three year study period up to 83.17 % of patients experienced at least one exacerbation. Predictive factors in the model were age, gender, previous exacerbations, influenza and 23-valent pneumococcal immunisations, number of previous visits to the General Practice and severity (GOLD), with an area under the ROC curve (AUROC) of 0.70.ConclusionsThis model can identify patients at high risk of acute exacerbation. Preventive measures and modification of treatment in these high-risk patients would improve survival.

Highlights

The risk of exacerbation in chronic obstructive pulmonary disease (COPD) depends on the severity of disease and other less well known factors
GOLD criteria were followed for the diagnosis of COPD: [25] a post bronchodilator FEV1/FVC
The following independent variables were collected at the beginning of the study: age, gender, spirometry results (FEV1/CVF, FVC, FEV1), comorbidities, history of smoking, 23valent pneumococcal and influenza immunisations for the 2009/10 season, years since COPD was diagnosed, number of visits to the health centre and number of acute exacerbations in the year prior to the start of the study, and COPD severity according to the GOLD Guidelines

Summary

Introduction

The risk of exacerbation in chronic obstructive pulmonary disease (COPD) depends on the severity of disease and other less well known factors. The objective was to design a model that predicts the risk of exacerbation in COPD. The global burden of chronic obstructive pulmonary disease (COPD) is high [1]. Some patients with COPD experience three episodes of acute exacerbation per year on average [2]. Predictive factors of exacerbation are still not completely understood [4,5,6,7,8,9]. Acute exacerbations are known to accelerate the severity of disease, [3] contribute to irreversible decline of pulmonary function [10], have a negative impact on quality of life [11] and decrease survival [12].

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