RESUMO
INTRODUCTION: The aim of this study was to describe the prognosis after hospitalization after exacerbation of chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: A retrospective study of 300 consecutively admitted patients with exacerbation of COPD in three departments of internal medicine with special interest in respiratory medicine. Data were collected from patient charts. RESULTS: The mean age was 71.3 years. 59.7% were women and 60.9% had cor pulmonale. In 44% of the patients hypoxia was documented at the time of admission. Twentysix(9%) patients died during hospitalization. After three and 12 months mortality was 19% and 36%, respectively. Age, cor pulmonale and hypoxia at the time of admission were associated with increased mortality, whereas impaired lung function, long term oxygen treatment, and a record of hospitalization with the same diagnosis in the previous 30 days were associated with increased mortality in univariate analysis, but not when adjusted for age, gender, and hypoxia at admission. The risk of readmission was increased in cor pulmonale, while cessation of smoking during hospitalization reduced this risk. DISCUSSION: Patients who have been hospitalized with exacerbation of COPD has a high mortality and a high risk of readmission.
Assuntos
Doença Pulmonar Obstrutiva Crônica , Idoso , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Fatores de RiscoRESUMO
A case of relapsing polychondritis in a 55-year-old man is described. The patient had suffered from recurrent pneumonia, bilateral auricular chondritis, unilateral hearing loss, skin lesions and an erosive seronegative polyarthritis. Biochemically, anemia, an elevated ESR and periodically elevated levels of C-reactive protein were present. A pulmonary function test showed an obstructive pattern. A computed tomography of the thorax and a bronchoscopy revealed tracheobronchial stenosis. The patient was treated with corticosteroids/methotrexate and ultimately a tracheobronchial stent due to worsened respiratory involvement.
Assuntos
Policondrite Recidivante , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Policondrite Recidivante/complicações , Policondrite Recidivante/diagnóstico , Policondrite Recidivante/tratamento farmacológicoRESUMO
A 55-year-old carpenter developed pleurisy with pleural effusion on the right side in 2000 and on the left side in 2003. No known causes of pleurisy were found. He had been occupationally exposed to asbestos during a 6-month-period in 1971 while working with roof sheets made of asbestos cement. In the literature there is evidence of asbestos being a cause of benign pleural effusion. We found it likely that the pleurisy with pleural effusion found in this patient was an occupational condition and it should therefore be notified as industrial injury.
Assuntos
Amianto/efeitos adversos , Doenças Profissionais/etiologia , Derrame Pleural/etiologia , Pleurisia/etiologia , Materiais de Construção/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Tomografia Computadorizada EspiralRESUMO
BACKGROUND: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. METHODS: We performed two audits of the hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. The indicators of quality of care comprised amongst others referral to pulmonary rehabilitation, smoking cessation advice, nutritional advice, instruction in inhalation technique and assessment of BMI, smoking status, pack years, lung function parameters, dyspnoea oxygen saturation and co-morbidities. RESULTS: In general, the quality of care for COPD patients in Denmark was suboptimal and not in accordance with the recently published guidelines both in the 1st and the 2nd audit. Yet, we observed a substantial improvement from the 1st to the 2nd audit. For example, referral to rehabilitation improved from 56.3 to 62.7% (p=0.006) Assessment of BMI improved from 7.8 to 56.1% and assessment of dyspnoea using MRC dyspnoea scale increased from 7.2 to 47.2% (both p<0.001). When analysing the results with focus on the performance of the individual outpatient clinics we also observed an improvement in the quality. CONCLUSION: We conclude that it is possible to improve the quality of care for COPD by focusing on a more systematic approach to the patient assessment by education of the staff of the outpatient clinics. A repeated and continuous education and discussion with the clinical staff is probably essential to reach an acceptable level of the quality of care for outpatients with COPD.