Frequency of self-reported COPD exacerbation and airflow obstruction in five Latin American cities: the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study.
BACKGROUND
Recurrent exacerbations are common in COPD patients. Limited information exists regarding exacerbation frequency in COPD patients from epidemiologic studies. We examined the frequency of self-reported exacerbations and the factors influencing exacerbation frequency among COPD patients in a population-based study conducted in Latin America.


METHODS
We used a post-bronchodilator FEV(1)/FVC ratio of < 0.70 to define COPD. Exacerbation was self-reported and defined by symptoms (deterioration of breathing symptoms that affected usual daily activities or caused missed work).


RESULTS
Spirometry was performed in 5,314 subjects. There were 759 subjects with airflow limitation; of these, 18.2% reported ever having had an exacerbation, 7.9% reported having an exacerbation, and 6.2% reported having an exacerbation requiring at least a doctor visit within the past year. The proportion of individuals with an exacerbation significantly increased by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, from 4.2% in stage 1 to 28.9% in stages 3 and 4. The self-reported exacerbation rate was 0.58 exacerbations per year. The rate of exacerbations requiring at least a doctor visit and length of stay in hospital due to exacerbations also increased as COPD severity progressed. The factors associated with having an exacerbation in the past year were dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and disease severity of GOLD stages 3 and 4.


CONCLUSIONS
The proportion of individuals with airflow limitation and self-reported exacerbation increases as the disease severity progresses. Dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and more severe obstruction were significantly associated with having an exacerbation in the past year.
Montes de Oca
Maria
M
Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela. Electronic address: mmdeoca@cantv.net.
Tálamo
Carlos
C
Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
Halbert
Ronald J
RJ
UCLA School of Public Health, Los Angeles, CA.
Perez-Padilla
Rogelio
R
Institute of Respiratory Diseases, Mexico City, Mexico.
Lopez
Maria Victorina
MV
Facultad de Medicina, Universidad de la República, Hospital Maciel, Montevideo, Uruguay.
Muiño
Adriana
A
Facultad de Medicina, Universidad de la República, Hospital Maciel, Montevideo, Uruguay.
Jardim
José Roberto B
JRB
Federal University of São Paulo, Sâo Paulo, Brazil.
Valdivia
Gonzalo
G
Departamento de Salud Publica, Facultad de Medicina, Pontifícia Universidad Católica de Chile, Santiago de Chile, Chile.
Pertuzé
Julio
J
Catedra de Neumologia, Facultad de Medicina, Pontifícia Universidad Católica de Chile, Santiago de Chile, Chile.
Moreno
Dolores
D
Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
Menezes
Ana Maria B
AMB
Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
D000368:Aged; D000402:Airway Obstruction / Q000453:epidemiology*; D004417:Dyspnea / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007843:Latin America; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014504:Urban Health