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Comorbidity as a contributor to frequent severe acute exacerbation in COPD patients
Suk Hyeon Jeong1, Hyun Lee1, K C Carriere2
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Insights
Asthma significantly increases the risk of frequent severe acute exacerbations (AEs) in patients with chronic obstructive pulmonary disease (COPD). Identifying and managing comorbidities like asthma is crucial for reducing severe AEs in COPD patients.
Area of Science:
- Pulmonology
- Internal Medicine
- Respiratory Medicine
Background:
- Comorbidities significantly impact severe acute exacerbations (AEs) in COPD patients.
- Previous research used general comorbidity indices, leaving individual disease contributions unclear.
- Understanding specific comorbidity impacts is vital for managing frequent severe AEs.
Purpose of the Study:
- To investigate the impact of comorbidities on frequent severe AEs in COPD patients.
- To identify specific risk factors, including comorbidities and COPD-related factors, for severe AEs.
- To clarify the role of individual diseases in exacerbation frequency.
Main Methods:
- Retrospective observational study of 77 COPD patients with severe AEs.
- 1-year follow-up to assess the incidence of frequent severe AEs (≥2 events).
- Analysis of COPD-related factors and comorbidities as potential risk factors.
Main Results:
- 37.7% of patients experienced frequent severe AEs within 1 year.
- Coexisting asthma (OR=4.02), home oxygen therapy (OR=9.39), and elevated C-reactive protein (OR=1.09) were associated with frequent severe AEs.
- Poor lung function (low FEV1) was inversely associated with early AEs.
Conclusions:
- Coexisting asthma is a significant comorbidity impacting frequent severe AEs in COPD.
- Home oxygen therapy and elevated CRP also contribute to exacerbation risk.
- Lung function is a key factor, particularly for early exacerbations.
Background:
Comorbidities have a serious impact on the frequent severe acute exacerbations (AEs) in patients with COPD. Previous studies have used the Charlson comorbidity index to represent a conglomerate of comorbidities; however, the respective contribution of each coexisting disease to the frequent severe AEs remains unclear.
Methods:
A retrospective, observational study was performed in 77 COPD patients who experienced severe AE between January 2012 and December 2014 and had at least 1-year follow-up period from the date of admission for severe AE. We explored the incidence of frequent severe AEs (≥2 severe AEs during 1-year period) in these patients and investigated COPD-related factors and comorbidities as potential risk factors of these exacerbations.
Results:
Out of 77 patients, 61 patients (79.2%) had at least one comorbidity. During a 1-year follow-up period, 29 patients (37.7%) experienced frequent severe AEs, approximately two-thirds (n=19) of which occurred within the first 90 days after admission. Compared with patients not experiencing frequent severe AEs, these patients were more likely to have poor lung function and receive home oxygen therapy and long-term oral steroids. In multiple logistic regression analysis, coexisting asthma (adjusted odds ratio [OR] =4.02, 95% confidence interval [CI] =1.30-12.46, P=0.016), home oxygen therapy (adjusted OR =9.39, 95% CI =1.60-55.30, P=0.013), and C-reactive protein (adjusted OR =1.09, 95% CI =1.01-1.19, P=0.036) were associated with frequent severe AEs. In addition, poor lung function, as measured by forced expiratory volume in 1 second (adjusted OR =0.16, 95% CI =0.04-0.70, P=0.015), was inversely associated with early (ie, within 90 days of admission) frequent severe AEs.
Conclusion:
Based on our study, among COPD-related comorbidities, coexisting asthma has a significant impact on the frequent severe AEs in COPD patients.
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