Acute Exacerbation of Chronic Obstructive Pulmonary Disease – Clinical Presentation and Predictors of Outcome
Main Article Content
Abstract
Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a common, costly and preventable disease and is at present the fourth leading cause of death globally. To study the outcome of patients with acute exacerbation of COPD and to analyse the risk factors predicting adverse outcomes in patients with acute exacerbation of COPD.
Patients and Methods: A Prospective study was conducted over a period of one year, from December 2021 to December 2022, Minimum of 50 patients, both male and female with AECOPD getting admitted to a Tertiary care centre were included in this study.
Results: Of the 50 patients studied, 42 were males; all of them were smokers (84%). The mean age was 64.34 ± 10.47 years. The mean duration of the disease was 10.04±6 years. All patients presented with cough, recent worsening of Dyspnea and increased sputum purulence/volume. 70% patients had one or more associated co-morbid illness, majority had hypertension (40%). Of 32 patients with Respiratory failure on admission 17(53.12%) patients had Type II and 15(46.28%) had Type I failure. 44 patients received medical management and 6 patients required invasive mechanical ventilation (IMV). Overall mortality was 5 (10%). 20 variables were compared between survivors and non-survivors. Univariate sensitivity analysis revealed that presence of altered sensorium (P=0.001), Hypotension (P=0.02), cyanosis (P=0.00463), pedal edema (P=0.02), presence of infection (P=0.024) Severe Acidosis (P=0.012), Hypercapnia (P=0.016), cor pulmonale (P=0.04), at the time of admission and need for invasive mechanical ventilation (P<0.001) as predictors of mortality.
Conclusions: 64% of AECOPD presented with respiratory failure, majority were type II. Overall mortality was 10%. Altered Sensorium, pedal edema, presence of infection, cyanosis, hypotension, severe acidosis, hypercapnia and presence of cor pulmonale at the time of admission predict adverse outcome. Those who need invasive mechanical ventilation had high mortality. Survivors had less hospital stay.
Keywords:
COPD, Cor pulmonale, Respiratory failure, Mechanical ventilation
Article Details
How to Cite
S, Gautam; ANTIN, Guruprasad; PUJAR, Kirankumar.
Acute Exacerbation of Chronic Obstructive Pulmonary Disease – Clinical Presentation and Predictors of Outcome.
Medical Research Archives, [S.l.], v. 11, n. 7.1, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4032>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i7.1.4032.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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31. Fagon J-Y, Chastre J, Trouillet J-L, et al. Characterization of distal bronchial micro flora during acute exacerbation of chronic bronchitis. Am Rev Respir Dis 1990;142:1004-8.
32. Pela R, Marchesani FF, Agostinelli C, et al. Airways microbial flora in COPD patients in stable clinical conditions and during exacerbations: a bronchoscopic investigation. Monaldi Arch Chest Dis 1998; 53:262-7.
33. Lieberman D, Lieberman D, Ben-Yaakov M, Lazarovich Z, Hoffman S, Ohana B, et al. Infectious etiologies in acute exacerbation of COPD. Diagn Microbiol Infect Dis 2001; 40:95-102.
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35. Arora N, Daga MK, Mahajan R, Prakash SK, Gupta N. Microbial pattern of acute infective exacerbation of chronic obstructive airway disease in a hospital based study. Indian J Chest Dis Allied Sci 2001; 43:157-162.
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40. Belman MJ, Botnick WC, Shin JW. Inhaled bronchodilators reduce dynamic hyperinflation during exercise in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 153:967-75.
41. Braun SR, McKenzie WN, Copeland C, et al. A comparison of the effect of ipratropium and albuterol in the treatment of chronic obstructive airway disease. Arch Intern Med 1989; 149:544-7.
42. McCrory DC, Brown CD. Anticholinergic bronchodilators versus beta2- sympatho mimetic agents for acute exacerbations of chronic obstructive pulmonary disease (Cochrane methodology review). The Cochrane Library. Issue 4 2003;Chichester, UK: John Wiley & Sons.
43. Turner MO, Patel A, Ginsburg S, et al. Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Arch Intern Med 1997;157:1736- 44.
44. Turner MO, Gafni A, Swan D, et al A review and economic evaluation of bronchodilator delivery methods in hospitalized patients. Arch Intern Med 1996;156:2113-18.
45. Levitt MA, Gambrioli EF, Fink JB. Comparative trial of continuous nebulization versus metered-dose inhaler in the treatment of acute bronchospasm. Ann Emerg Med 1995;26:273-7.
46. Saetta M, Di Stefano A, Maestrelli P, et al. Airway eosinophilia in chronic bronchitis during exacerbations. Am J Respir Crit Care Med 1994; 150:1646-52.
47. Bhowmik A, Seemungal TAR, Sapsford RJ, et al. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax 2000;55:114-20.
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