Clinical Characterization and Treatment Patterns for the Frequent Exacerbator Phenotype in Chronic Obstructive Pulmonary Disease with Severe or Very Severe Airflow Limitation.
Chronic obstructive pulmonary disease (COPD) patients experiencing several episodes of acute clinical derangement suffer from increased morbidity, mortality, and accelerated decline in lung function. Nevertheless, the relationship between co-morbidity profile and exacerbation rates in the frequent exacerbator phenotype is poorly characterized, and evidence-based management guidelines are lacking. We sought to evaluate the co-morbidity profile and treatment patterns of "frequent exacerbators" with severe or very severe airflow limitation. We conducted a cross-sectional, multicenter study in 50 Italian hospitals. Pulmonologists abstracted clinical information from medical charts of 743 COPD frequent exacerbators. We evaluated the exacerbation risk and center-related variations in diagnostic testing. One-third of patients (n = 210) underwent a bronchodilator response test, and 163 (22%) received a computerized tomography (CT) scan; 35 had a partial response to bronchodilators, while 119 had a diagnosis of emphysema; 584 (79%) lacked sufficient diagnostic testing for classification. Only 17% of patients did not have any coexistent disease. Cardiovascular conditions were the most frequent co-morbidities. A history of heart failure [odds ratio (OR): 1.89; 95% confidence interval (CI) 1.48-2.3] and affective disorders (OR: 1.66; 95% CI 1.24-2.1) was associated with the frequency of exacerbations. Center membership was strongly associated with exacerbation risk, independent of casemix (variance partition coefficient = 29.6%). Examining the regional variation in health outcomes and health care behavior may help identify the best practices, especially when evidence-based recommendations are lacking and uncertainties surround clinical decision-making.
a Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti , University of Milan , Milan , Italy.
Francesco
F
Blasi
b Care Value Advanced Analytics , Fresenius Medical Care , Palazzo Pignano , Italy.
Luca
L
Neri
c Dipartimento di Scienze della Salute , University of Milan , Milan , Italy.
Stefano
S
Centanni
d Unità Operativa di Malattie dell'Apparato Respiratorio, PneumoTisiatria , Presidio Ospedaliero Bellaria-Maggiore Azienda USL della Città di Bologna , Bologna , Italy.
Franco
F
Falcone
e Unità Operativa di Pneumologia , Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele , Catania , Italy.
Giuseppe
G
Di Maria
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology*; D010024:Osteoporosis / Q000453:epidemiology; D010641:Phenotype; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D011656:Pulmonary Emphysema / Q000175:diagnosis; D051437:Renal Insufficiency / Q000453:epidemiology; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents
COPD; Coexistent diseases; epidemiology; frequent exacerbator phenotype; treatment pattern