Frequent hospital readmissions for acute exacerbation of COPD and their associated factors

The factors that determine frequent hospital readmissions for acute exacerbations of COPD (AECOPD) are poorly understood. The aim of this study was to ascertain rates of re-hospitalizations for AECOPD patients and evaluate factors associated with frequent readmissions for acute exacerbations.

We conducted a cross-sectional survey of 186 patients with moderate to severe COPD with one or more admissions for acute exacerbations to two large general hospitals. Frequency of previous readmissions for AECOPD in the past year, and clinical characteristics, including depression and spirometry were ascertained in the stable state both before discharge and at 1-month post discharge.

Among them, 67% had one or more previous readmission, 46% had two or more, 9% had 10-20 readmissions in the 1-year period prior to current admission. There was a high prevalence of current or ex-heavy smokers, underweight patients, depression and consumption of psychotropic drugs, and low prevalence of caregiver support, pulmonary rehabilitation and influenza and pneumococcal vaccination. Univariate analysis showed that male sex, duration >5 years, FEV(1) < 50% predicted, use of psychotropic drugs, receipt of pulmonary rehabilitation and vaccination were significantly associated with frequent past readmissions. Multivariate analysis revealed that disease duration >5 years (odds ratio (OR) = 2.32; 95% confidence interval (CI): 1.09-4.92), FEV(1) < 50% predicted (OR = 2.60; 95% CI: 1.18-5.74), use of psychotropic drugs (OR = 13.47; 95% CI: 1.48-122.92) and vaccination status (OR = 3.27; 95% CI: 1.12-9.57) were independently associated with frequent readmissions for AECOPD.

Frequent past readmission for AECOPD was associated with disease severity and psychosocial distress and increased use of vaccinations.