RESUMEN
What Is an Acute COPD Exacerbation? Results of a Survey among Primary Care Physicians in the German-Speaking Part of Switzerland Abstract. Acute exacerbations have a relevant impact on morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD), which is why prophylactic and early treatment have become indispensable. However, COPD exacerbations are significantly under-diagnosed, possibly due to linguistic discrepancies between physician and patient. The aim of this study was to disclose how exacerbations are perceived by the GPs (general practitioners) and their patients and what linguistic conventions they use. This survey showed that GPs and their patients quite often have a divergent notion a common of COPD exacerbations.
Asunto(s)
Médicos de Atención Primaria , Humanos , SuizaAsunto(s)
Enfermedad Pulmonar Obstructiva Crónica/psicología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Calidad de Vida/psicología , Progresión de la Enfermedad , Ejercicio Físico , Humanos , Gripe Humana/complicaciones , Gripe Humana/prevención & control , Educación del Paciente como Asunto , Neumonía Neumocócica/complicaciones , Neumonía Neumocócica/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/prevención & control , Autocuidado , Cese del Hábito de Fumar , Espirometría , Suiza , VacunaciónRESUMEN
BACKGROUND: Prognostic factors for clinical failure of acute exacerbation in patients with COPD (AECOPD) are of special importance in order to choose an adequate therapy and resources during inpatient treatment. Our database was analyzed to identify predictors for a negative outcome. MATERIALS AND METHODS: In a retrospective analysis medical records of 616 patients (299 women; 317 men) hospitalized for AECOPD between January 2011 and January 2016 were analyzed in order to evaluate demographic and clinical parameters leading to adverse events. Only the first admission was considered. Logistic regression analysis was performed to determine the relative risk (odds ratio (OR) leading to severe adverse events such as intensive care unit (ICU) admission, mechanical ventilation (invasive or noninvasive), early readmission to ICU and hospital and death). RESULTS: An increased risk of an ICU admission was found for patients with a coronary heart disease (OR = 5.734; p = 0.009) and for patients requiring an antibiotic therapy (OR = 11.721; p = 0.003). An increased risk for rehospitalisation and mortality was found for age (OR = 1.034; p = 0.028) and a longer duration of the hospital stay (OR = 1.063; p = 0.042). A lower Creactive protein (CRP) level was associated with a lower risk of readmission to the hospital (OR = 0.991; p = 0.03). An increased risk of ventilator therapy was found for patients with chronic heart failure (OR = 6.166; p = 0.02) and sleep apnea syndrome (OR = 6.698; p = 0.003), diabetes (OR = 3.754; p = 0.041) and a long stay in the ICU (OR = 2.018; p = 0.000). CONCLUSIONS: Comorbidities in patients with AECOPD were found to be a major risk factor for ICU admission and mechanical ventilation. Elderly patients and patients with prolonged hospital stay showed a higher risk for readmission and mortality. Patients with a low CRP blood level seemed to have a lower risk for rehospitalisation.