More than one third of patients with a first acute exacerbation of chronic obstructive pulmonary disease (COPD) died within 4 years in a recent small study presented by Kamil Klenha, MD, and colleagues from the Regional Hospital Tabor in the Czech Republic.
The study included 80 patients with a first acute COPD exacerbation who met the GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria for hospitalization. The patients were treated in a nonintensive care unit ward; the cause of exacerbation was infectious in 57.5% of the patients and noninfectious in 42.5%.
Patients were treated according to current recommendations and were monitored every 3 to 6 months in the hospital’s outpatient clinic. By year 4 of follow-up, 35% of the group had died—7 patients during the first year, 8 during the second year, 7 during the third year, and 6 during the fourth year.
The mortality in this case series was not as high as in other series, some of which are as high as 59%; this likely reflects the absence of patients with the most severe disease, because no patients required treatment in an intensive care unit ward, according to the researchers. Significant predictors of mortality were:
- Older age
- Worsening lung function as determined by a lower forced expiratory volume in 1 second
- Frequent acute exacerbations
- A history of smoking.
Current smokers, as well as those who quit <10 years earlier, had 3.8 times the risk for death compared with lifelong nonsmokers or those who quit ≥10 years earlier.
Hypoxemia and/or hypercapnia were associated with a more than doubling of the risk for mortality.
The researchers concluded that their data confirm the seriousness of an acute exacerbation.