2008 Predictors of Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Exacerbation in Hong Kong: A 9-month Prospective Cohort Study
Dr Tse Hoi Nam
Department of Medicine, Kwong Wah Hospital
Objectives
The aim of this study is to analyze the predictors of hospitalization for acute exacerbation of COPD (AECOPD) in a 9-month period as well as to investigate the utilization pattern of health care services by COPD patients in Hong Kong.
Design
A 9-month prospective cohort study
Settings and study populations
276 COPD patients were recruited in the Prince of Wales Hospital and Kwong Wah Hospital (in either outpatient or inpatient settings) between the period 1/10/2005 and 30/4/2007 and the subjects were then followed up for 9 months.
Methods
Information including demographics, smoking history, symptomatology, comorbidities, spirometric data, current COPD treatments and the utilization of health care service in the previous 12 months were obtained via a questionnaire. Subjects were then reassessed 9 months later to find out if there had been any COPD related hospitalizations during the period.
Results
At baseline, 276 patients (Gender: male 87%, Age: 74.9+/- 8.43, BMI: 21.56 +/- 4.04, FEV1% predicted: 47.87+/- 22.59) were recruited. Severe COPD subjects (GOLD stage 4) had the most frequent admissions in the past 12 months (1.89 vs. 0.76 episodes). In contrast, the mild COPD subjects (GOLD stage 1) had the greatest utilization of community health care services.
At the point of reassessment (9 months later), 86 patients had been admitted for COPD exacerbation during the 9-month period.
Univariate analysis showed that predictors for COPD related hospitalization included BMI, the duration of disease, degree of dyspnoea (MRC grading), severity of airway obstruction (FEV1% predicted), pattern of health care services utilization (the number of COPD exacerbation, hospitalization, routine specialist contact in prior year) and the current treatment received (use of home oxygen, inhaled steroid, short acting beta agonist (SABA) and the combined inhaled steroid and long acting beta-agonist).
Multivariate analysis showed predictors of hospitalization included low BMI (Odd Ratio[OR]: 0.901, 95% CI: 0.830-0.979, p=0.013), the number of admissions for AECOPD in the prior year (OR:1.291, 95% CI: 1.032-1.614, p=0.025), the use of home oxygen (OR: 3.483, 95% CI: 1.475-8.223, p=0.004) and regular use of inhaled steroid (OR: 2.210, 95% CI: 1.147-4.261, p=0.018). In contrast, regular respiratory specialist visits in the past 12 months (OR: 0.726, 95% CI: 0.570-0.923, p=0.009) was associated with a decrease in COPD related hospitalizations.
Conclusion
Like all other diseases, the utilization pattern of health care services tends to shift from community to hospital with increasing severity of COPD. Improving nutritional status and paying regular visits to respiratory specialist clinics may decrease COPD related hospitalization.
