title: A search for covert precipitating clinical parameters in frequent exacerbators of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Acute exacerbations are a significant source of morbidity and mortality associated with chronic obstructive pulmonary disease (COPD). Some patients suffer an inordinate number of exacerbations while others remain relatively protected. The aim of this study was to evaluate the potentially modifiable precipitating parameters of frequent severe exacerbations requiring hospital admission in COPD.
  
  
  METHODS
  Consecutive patients admitted with acute exacerbation of COPD for a period of one year in a tertiary care hospital were evaluated prospectively. 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 98 COPD patients (81.63% men) admitted consecutively with exacerbations in our department. The mean number of severe exacerbations was (2.42 per patient/per year), and 65% of the patients had frequent severe exacerbations. Multivariate analysis indicated that serum uric acid, serum total IgE, depression and anxiety, gastroesophageal reflux disease symptoms, air pollution, poor adherence to inhaled therapy, and irregular outpatient followup visits were independent predictors of frequent severe exacerbations.
  
  
  CONCLUSIONS
  COPD 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. Raised serum total IgE levels may point towards atopy as an additional comorbidity in COPD while uric acid can have a clinically useful role in risk stratification in a primary care setting.
authors.affiliation: Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ankit
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ved
authors.initials: V
authors.lastname: Prakash
authors.affiliation: Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Surya
authors.initials: S
authors.lastname: Kant
authors.affiliation: Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Verma
keywords: Chronic obstructive pulmonary disease; exacerbation; serum IgE; uric acid