title: Incidence and risk factors of exacerbations among COPD patients in primary health care: APMPOC study.
abstract: BACKGROUND
  Worldwide, chronic obstructive pulmonary disease (COPD) is the fourth cause of death. Exacerbations have a negative impact on the prognosis of COPD and the frequency and severity of these episodes are associated with a higher patient mortality. Exacerbations are the first cause of decompensation, hospital admission and death in COPD. The incidence of exacerbations has mainly been estimated in populations of patients with moderate-severe COPD requiring hospital care. However, little is known regarding the epidemiology of exacerbations in patients with less severe COPD forms. It is therefore possible that a high number of these less severe forms of exacerbations are underdiagnosed and may, in the long-term, have certain prognostic importance for the COPD evolution. The aim of this study was to know the incidence and risk factors associated with exacerbations in patients with COPD in primary care.
  
  
  METHODS
  A prospective, observational, 3-phase, multicentre study will be performed involving: baseline evaluation, follow up and final evaluation. A total of 685 smokers or ex-smokers from 40 to 80 years of age with COPD, without acute respiratory disease or any other long-term respiratory disease will be randomly selected among the population assigned to 21 primary care centres. The diagnosis of COPD and its severity will be confirmed by spirometry. Information regarding the baseline situation, quality of life and exposure to contaminants or other factors potentially related to exacerbations will be collected. A group of 354 patients with confirmed COPD of varying severity will be followed for one year through monthly telephone calls and daily reporting of symptoms with the aim of detecting all the exacerbations which occur. These patients will be evaluated again at the end of the study and the incidence of exacerbations and associated relative risks will be estimated by negative binomial regression.
  
  
  CONCLUSIONS
  The results will be relevant to provide knowledge about natural history of the initial phases of the COPD and the impact and incidence of the exacerbations on the patients with mild-moderate forms of the disease. These data may be important to know the milder forms of exacerbation which are often silent or very little expressed clinically.
authors.affiliation: Primary Healthcare Research Support Unit Barcelonès Nord i Maresme, IDIAP Jordi Gol, Mataró, Spain. eborrell.bnm.ics@gencat.net
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Borrell
authors.forename: Mar
authors.initials: M
authors.lastname: Rodríguez
authors.forename: Pere
authors.initials: P
authors.lastname: Torán
authors.forename: Laura
authors.initials: L
authors.lastname: Muñoz
authors.forename: Guillem
authors.initials: G
authors.lastname: Pera
authors.forename: Núria
authors.initials: N
authors.lastname: Montellà
authors.forename: Mònica
authors.initials: M
authors.lastname: Monteagudo
authors.forename: Magalí
authors.initials: M
authors.lastname: Urrea
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Puigfel
authors.forename: Antonio
authors.initials: A
authors.lastname: Negrete
authors.forename: Xavier
authors.initials: X
authors.lastname: Mezquiriz
authors.forename: Cristina
authors.initials: C
authors.lastname: Domènech
authors.forename: Anna
authors.initials: A
authors.lastname: Lacasta
authors.forename: Ma Llum
authors.initials: ML
authors.lastname: García
authors.forename: Sandra
authors.initials: S
authors.lastname: Maneus
authors.forename: Glòria
authors.initials: G
authors.lastname: Tintoré
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D019370:Observation; D011320:Primary Health Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors