Citation Information :
Kshatriya RM, Paliwal RP, Khara NV, Patel SN. Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Rural Area: Why, How, and What Next?. Indian J Respir Care 2019; 8 (2):92-95.
Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to fall in lung function, quality of life, and ultimately disease progression. The present study is an effort to study in detail about COPD exacerbation in a rural tertiary hospital.
Aim: To study demographic, clinical, and laboratory profile of hospitalized patients of AECOPD.
Methodology: Retrospective data of 170 consecutive patients of AECOPD were collected from records, were divided into two groups based on severity, and were analyzed: Group 1 for admission in the wards and Group 2 for intensive care unit (ICU) admissions.
Results: A total of 141 (82.9%) patients were hospitalized in the wards, whereas 29 (17.1%) were admitted in the ICU. The mean age was 62.36 years in the wards and 64.89 years in the ICU. Nearly 89.4% of patients were smokers. Dyspnea (100%) was the most common symptom followed by cough (99%) and expectoration (98%). The mean respiratory rate at the time of presentation was 26/min in the wards and 31.56/min in the ICU. The mean oxygen saturation was 93% in the wards and 88.62% in the ICU. The mean post forced expiratory volume in 1 s (FEV1) was 43.98% in ward patients and 29.28% among ICU patients. Arterial blood gas revealed mean PaCO2 of 44.25 mmHg in the wards and 63.24 mmHg in the ICU. The mean pH in the ward was 7.48 compared to 7.34 in the ICU. The mean pulmonary arterial pressure (PAP) was higher in the ICU (53.74 mmHg) than in the ward (38.87 mmHg).
Conclusion: The ratio of hospitalization in ICU to ward was 1:5. The site of treatment depends on respiratory rate, oxygen saturation, post-FEV1%, PAP, pH, and PaCO2.
Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD science committee report 2019. Eur Respir J 2019. pii: 1900164.
Garcia-Aymerich J, Monsó E, Marrades RM, Escarrabill J, Félez MA, Sunyer J, et al. Risk factors for hospitalization for a chronic obstructive pulmonary disease exacerbation. EFRAM study. Am J Respir Crit Care Med 2001;164:1002-7.
Ghoshal AG, Dhar R, Kundu S. Treatment of acute exacerbation of COPD. Supplement To J Assoc Physicians India 2012;60:38-43.
Mohapatra PR, Janmeja AK. Factors associated with hospital admission in patients with acute exacerbation of chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2010;52:203-6.
Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;159:158-64.
Roberts CM, Lowe D, Bucknall CE, Ryland I, Kelly Y, Pearson MG. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax 2002;57:137-41.
Mohan A, Premanand R, Reddy LN, Rao MH, Sharma SK, Kamity R, et al. Clinical presentation and predictors of outcome in patients with severe acute exacerbation of chronic obstructive pulmonary disease requiring admission to intensive care unit. BMC Pulm Med 2006;6:27.
Donaldson GC, Goldring JJ, Wedzicha JA. Influence of season on exacerbation characteristics in patients with COPD. Chest 2012;141:94-100.
Garcia-Gutierrez S, Quintana JM, Bilbao A, Unzurrunzaga A, Esteban C, Baré M, et al. Validity of criteria for hospital admission in exacerbations of COPD. Int J Clin Pract 2014;68:820-9.
Oostenbrink JB, Rutten-van Mölken MP. Resource use and risk factors in high-cost exacerbations of COPD. Respir Med 2004;98:883-91.
Sinha N, Christopher DJ, Prakash J, James P. Prospective study of infectious bacterial etiology of acute exacerbation of chronic obstructive pulmonary disease in India. F1000Research 2010;1.
Hurst JR, Donaldson GC, Wilkinson TM, Perera WR, Wedzicha JA. Epidemiological relationships between the common cold and exacerbation frequency in COPD. Eur Respir J 2005;26:846-52.
Chrystyn H, Small M, Milligan G, Higgins V, Gil EG, Estruch J. Impact of patients' satisfaction with their inhalers on treatment compliance and health status in COPD. Respir Med 2014;108:358-65.