title: The Effect of Incidental Consolidation on Management and Outcomes in COPD Exacerbations: Data from the European COPD Audit.
abstract: OBJECTIVE
  There is controversy regarding the significance of radiological consolidation in the context of COPD exacerbation (eCOPD). While some studies into eCOPD exclude these cases, consolidation is a common feature of eCOPD admissions in real practice. This study aims to address the question of whether consolidation in eCOPD is a distinct clinical phenotype with implications for management decisions and outcomes.
  
  
  METHODS
  The European COPD Audit was carried out in 384 hospitals from 13 European countries between 2010 and 2011 to analyze guideline adherence in eCOPD. In this analysis, admissions were split according to the presence or not of consolidation on the admission chest radiograph. Groups were compared in terms of clinical and epidemiological features, existing treatment, clinical care utilized and mortality.
  
  
  RESULTS
  14,111 cases were included comprising 2,714 (19.2%) with consolidation and 11,397 (80.8%) without. The risk of radiographic consolidation increased with age, female gender, cardiovascular diseases, having had two or more admissions in the previous year, and sputum color change. Previous treatment with inhaled steroids was not associated. Patients with radiographic consolidation were significantly more likely to receive antibiotics, oxygen and non-invasive ventilation during the admission and had a lower survival from admission to 90-day follow-up.
  
  
  CONCLUSIONS
  Patients admitted for COPD exacerbation who have radiological consolidation have a more severe illness course, are treated more intensively by clinicians and have a poorer prognosis. We recommend that these patients be considered a distinct subset in COPD exacerbation.
authors.affiliation: UCL Respiratory Medicine, University College London, London, United Kingdom.
authors.forename: Aarash
authors.initials: A
authors.lastname: Saleh
authors.affiliation: Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Centro de investigación en red de enfermedades respiratorias (CIBERES), Instituto de, Salud Carlos III, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: López-Campos
authors.affiliation: Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Vienna, Austria.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Hartl
authors.affiliation: Hospital 12 de Octubre, Instituto de Investigacion i+12, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Pozo-Rodríguez
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Roberts
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate