title: Unsuspected risk factors of frequent exacerbations requiring hospital admission in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Severe exacerbations are the leading cause of fatal events in chronic obstructive pulmonary disease (COPD). The new Global Initiative for Chronic Obstructive Lung Disease strategy included the number of exacerbations in the grading of the disease. The primary aim of this study was to evaluate the potentially modifiable precipitating factors of frequent severe exacerbations requiring hospital admission in COPD. The secondary aim was to investigate the risk factors of readmission within 2 months following an exacerbation requiring hospitalisation.
  
  
  METHODS
  Data regarding the number of exacerbations in the previous year, current comorbidities, medications, and clinical and functional status of COPD patients were evaluated.
  
  
  RESULTS
  We included 107 COPD patients (85% men). The mean number of severe exacerbations was 1.3 ± 1.7 (per patient/per year), and 37.4% of the patients had frequent severe exacerbations (≥ 2/year). Multivariate analysis indicated that haematocrit < 41%, angiotensin converting enzyme inhibitor or angiotensin receptor blocker use, positive gastro-oesophageal reflux disease symptoms, poor adherence to inhaled therapy/regular outpatient follow-up visits and FEV1 < 50% were independent predictors of frequent severe exacerbations. Readmission rate within 2 months after hospital discharge was 39.3%. The independent risk factors of readmission were poor adherence to inhaled therapy/regular outpatient follow-up visits, serum haematocrit < 41%, and FEV1 < 50%.
  
  
  CONCLUSIONS
  Chronic obstructive pulmonary disease patients with frequent exacerbations should be carefully assessed for modifiable confounding risk factors regardless of poor lung function to decrease exacerbation frequency and related poor prognosis.
authors.affiliation: Department of Pulmonary Disease, Cukurova University Faculty of Medicine, Adana, Turkey. ezgiozyilmaz@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Ozyilmaz
authors.forename: N
authors.initials: N
authors.lastname: Kokturk
authors.forename: G
authors.initials: G
authors.lastname: Teksut
authors.forename: T
authors.initials: T
authors.lastname: Tatlicioglu
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000368:Aged; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010359:Patient Readmission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D012008:Recurrence; D012129:Respiratory Function Tests; D012307:Risk Factors