Physical, Psychological, and Social Factors Associated with Exacerbation-Related Hospitalization in Patients with COPD.

BACKGROUND AND OBJECTIVE: Exacerbation(s) of chronic obstructive pulmonary disease (eCOPD) entail important events describing an acute deterioration of respiratory symptoms. Changes in medication and/or hospitalization are needed to gain control over the event. However, an exacerbation leading to hospitalization is associated with a worse prognosis for the patient. The objective of this study is to explore factors that could predict the probability of an eCOPD-related hospitalization. METHODS: Data from 128 patients with COPD included in a prospective, longitudinal study were used. At baseline, physical, emotional, and social status of the patients were assessed. Moreover, hospital admission during a one year follow-up was captured. Different models were made based on univariate analysis, literature, and practice. These models were combined to come to one final overall prediction model. RESULTS: During follow-up, 31 (24.2%) participants were admitted for eCOPD. The overall model contained six significant variables: currently smoking (OR = 3.93), forced vital capacity (FVC; OR = 0.97), timed-up-and-go time (TUG-time) (OR = 14.16), knowledge (COPD knowledge questionnaire, percentage correctly answered questions (CIROPD%correct)) (<60% (OR = 1.00); 60%-75%: (OR = 0.30); >75%: (OR = 1.94), eCOPD history (OR = 9.98), and care dependency scale (CDS) total score (OR = 1.12). This model was well calibrated (goodness-of-fit test: p = 0.91) and correctly classified 79.7% of the patients. CONCLUSION: A combination of TUG-time, eCOPD-related admission(s) prior to baseline, currently smoking, FVC, CDS total score, and CIROPD%correct allows clinicians to predict the probability of an eCOPD-related hospitalization.

The stability of the ADO score among UK COPD patients from The Health Improvement Network.

The ADO (age, dyspnoea, airflow obstruction) score predicts 3-year overall mortality among chronic obstructive pulmonary disease (COPD) patients. Information on the changes in COPD prognostic scores is sparse and it is unclear if the ADO score should be measured serially. We followed 4804 UK COPD patients with three or more ADO measurements from The Health Improvement Network (2005-2014) in a retrospective open cohort design. Patient's ADO scores were calculated once per year unless an obstruction or dyspnoea measurement was missing. Cox regression models assessed the independent role of serial ADO scores on mortality. The associations between baseline patient characteristics and long-term change in ADO scores were assessed using linear mixed effect models. Fewer than 7% of patients had worsened (i.e. increased) by ≥1 point per year after a median follow-up of 4.4 years. There was strong evidence that patients with more rapid worsening in ADO scores had increased mortality (hazard ratio 2.00 (95% CI 1.59-2.52) per 1 point increase in ADO per year). More rapid ADO score worsening was seen among current smokers (rate difference 0.059 (95% CI 0.031-0.087); p=0.001) and ex-smokers (0.028 (95% CI 0.003-0.054); p=0.032) and patients with depression (0.038 (95% CI 0.005-0.071); p=0.022), while overweight (-0.0347 (95% CI -0.0544- -0.0150); p=0.001) and obese (-0.0412 (95% CI -0.0625- -0.0198); p<0.001) patients had a less rapid ADO score worsening. Serial assessment of the ADO score can identify patients with worsening disease and update their prognosis, especially for patients who smoke, are depressed or have lower body mass index.

External Validation Of The Updated ADO Score In COPD Patients From The Birmingham COPD Cohort.

Background: Reviews suggest that the ADO score is the most discriminatory prognostic score for predicting mortality among chronic obstructive pulmonary disease (COPD) patients, but a full evaluation and external validation within primary care settings is critical before implementation. Objectives: To validate the ADO score in prevalent and screen-detected primary care COPD cases at 3 years and at shorter time periods. Patients and methods: One thousand eight hundred and ninety-two COPD cases were recruited between 2012 and 2014 from 71 United Kingdom general practices as part of the Birmingham COPD Cohort study. Cases were either on the practice COPD register or screen-detected. We validated the ADO score for predicting 3-year mortality with 1-year and 2-year mortality as secondary endpoints using discrimination (area-under-the-curve (AUC)) and calibration plots. Results: One hundred and fifty-four deaths occurred within 3 years. The ADO score was discriminatory for predicting 3-year mortality (AUC= 0.74; 95% CI: 0.69-0.79). Similar performance was found for 1- (AUC= 0.73; 0.66-0.80) and 2-year mortality (0.72; 0.67-0.76). The ADO score showed reasonable calibration for predicting 3-year mortality (calibration slope 0.95; 0.70-1.19) but over-predicted in cases with higher predicted risks of mortality at 1 (0.79; 0.45-1.13) and 2-year (0.79; 0.57-1.01) mortality. Discussion: The ADO score showed promising discrimination in predicting 3-year mortality in a primary care population including screen-detected cases. It may need to be recalibrated if it is used to provide risk predictions for 1- or 2-year mortality since, in these time-periods, over-prediction was evident, especially in cases with higher predicted mortality risks.

Trends in moderate and severe exacerbations among COPD patients in the UK from 2005 to 2013.

INTRODUCTION: Exacerbations of chronic obstructive pulmonary disease are characterised by increased symptoms such as dyspnoea, cough and sputum production and/or purulence, leading to greater risk of hospitalisation and mortality. Very few studies have measured long term trends in the incidence of exacerbations of chronic obstructive pulmonary disease. We therefore investigated the incidence of moderate and severe exacerbations in the UK general population. METHODS: A population based-study including Clinical Practice Research Datalink (CPRD) patients ≥ 40 years of age with a current diagnosis of COPD within the United Kingdom from 2004 to 2013 was conducted. Individuals with a history of asthma were excluded from main analyses. We calculated the incidence rates for any, moderate, and severe exacerbations. Patients contributed time at risk from January 1st up to the date of the first outcome within each year. The incidence rate for any, moderate and severe exacerbations for COPD in each calendar year was calculated as follows: the sum of any or moderate or severe exacerbations for COPD in that year divided by the total duration of follow-up in the same calendar year from 2005 through to 2013. We then analysed these rates by gender and age categories (40-59 years, 60-79 years and ≥80 years). RESULTS: Among 213,561 with incident COPD diagnosis, 86,300 patients were included in the study. From 2005 to 2013, the incidence rate of any exacerbations increased from 89 to 98 per 1000 person years (PYs) (p = 0.005). Women had significantly higher incidence rates of any exacerbation for each calendar year when compared to men (p < 0.0001). The incidence rate of any and moderate exacerbations increased with age from 2005 to 2007. For severe exacerbations incidence decreased from 2005 to 2007 before increasing from 2008 until the end of follow-up (43 per 1000 PYs (95% confidence interval, 42-45/1000PYs) in 2013). Incidence rates of severe exacerbations were similar by gender and patients aged 80 + years had a higher incidence rate of severe exacerbation from 2005 to 2008 after which their incident rate dropped in subsequent years. CONCLUSION: This is the first study that reports the long-term changes in the incidence rates of moderate and severe exacerbations within the UK general practice. Women showed a substantially higher risk of any COPD exacerbations, and their risk is increasing. The incidence rates of any exacerbations increased during the study period, while severe exacerbations were variable. Furthermore, incidence rates varied substantially by age group.