title: Frequency and risk factors of COPD exacerbations and hospitalizations: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study).
abstract: BACKGROUND
  COPD exacerbations and hospitalizations have been associated with poor prognosis for the COPD patient.
  
  
  OBJECTIVE
  To evaluate the frequency and risk factors of COPD exacerbations, hospitalizations, and admissions to intensive care units (ICUs) in Greece by a nationwide cross-sectional study.
  
  
  METHODS
  A nationwide observational, multicenter, cross-sectional study was conducted in the clinical practice setting of respiratory medicine physicians over a 6 month-period (October 2010 to March 2011). A total of 6,125 COPD patients were recruited by 199 respiratory physicians.
  
  
  RESULTS
  Participants had a median age of 68.0 years, 71.3% were males, and 71.8% suffered from comorbidities. The median disease duration was 10.0 years. Of the patients, 45.3% were classified as having GOLD (Global initiative for chronic Obstructive Lung Disease) stage III or IV COPD. Patients with four or more comorbidities had 78.5% and threefold-higher than expected number of exacerbations and hospitalizations, respectively, as well as fivefold-higher risk of admission to the ICU compared to those with no comorbidities. Obese patients had 6.2% fewer expected exacerbations compared to those with a normal body mass index. Patients with GOLD stage IV had 74.5% and fivefold-higher expected number of exacerbations and hospitalizations, respectively, and nearly threefold-higher risk of admission to the ICU compared to stage I patients. An additional risk factor for exacerbations and hospitalizations was low compliance with treatment: 45% of patients reported forgetting to take their medication, and 81% reported a preference for a treatment with a lower dosing frequency.
  
  
  CONCLUSIONS
  Comorbidities, disease severity, and compliance with treatment were identified as the most notable risk factors for exacerbations, hospitalizations, and ICU admissions. The results point to the need for a multifactorial approach for the COPD patient and for the development of strategies that can increase patient compliance with treatment.
authors.affiliation: School of Social Sciences, Hellenic Open University, Patras, Greece.
authors.forename: Evangelos C
authors.initials: EC
authors.lastname: Alexopoulos
authors.affiliation: Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece.
authors.forename: Foteini
authors.initials: F
authors.lastname: Malli
authors.affiliation: Medical Department, Novartis Hellas, Athens, Greece.
authors.forename: Eirini
authors.initials: E
authors.lastname: Mitsiki
authors.affiliation: Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece.
authors.forename: Eleni G
authors.initials: EG
authors.lastname: Bania
authors.affiliation: Medical Department, Novartis Hellas, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Varounis
authors.affiliation: School of Social Sciences, Hellenic Open University, Patras, Greece.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Gourgoulianis
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006115:Greece / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; ICU admissions; exacerbations; hospitalizations; risk factors