Open Access Gateway
Med Princ Pract 2005;14:35–40
(DOI:10.1159/000081921)

Prognostic Factors in the Management of Exacerbation of Chronic Obstructive Pulmonary Disease in Kuwait

Onadeko B.O.a · Khadadah M.a · Abdella N.a · Mukhtar M.b · Mourou M.b · Qurtom M.b · Samad M.b · Al-Shayeb A.b
aDepartment of Medicine, Faculty of Medicine, Kuwait University and bMubarak Al-Kabeer Hospital, Kuwait
email Corresponding Author


 goto top of outline Key Words

  • Chronic obstructive pulmonary disease
  • Exacerbation
  • Management
  • Prognostic factors
  • Kuwait

 goto top of outline Abstract

Objective: To evaluate the clinical presentation and the factors of prognostic importance in the management of exacerbation of chronic obstructive pulmonary disease (COPD). Subjects and Methods: One hundred and four patients who were hospitalized because of exacerbation of COPD between 1996 and 2000 were selected for further evaluation. Only patients who fulfilled the American Thoracic Society criteria for diagnosis of COPD were included. The factors examined included age, clinical features, duration of symptoms of exacerbation, severity of underlying disease, comorbid diseases, level of consciousness, previous hospitalization, intubation and assisted ventilation, hypercapnia, degree of acidemia and complications. Results: Seventy-four of 104 (71%) hospitalized patients reviewed met the inclusion criteria for COPD. The mean age was 63.68 ± 12.6 years. There was a male:female ratio of 3:1. Fifty-eight patients (78%) had a baseline FEV1 <50% before hospitalization and 45 (64%) had previous hospitalization. Comorbid disease was found in 50% of the cases, while 78% had acidemia and 70% hypercapnia. Fourteen (19%) died on admission. Risk factors identified included severity of disease (p < 0.05); presence of comorbid disease (p < 0.01); acidemia (p < 0.0001); hypercapnia (p < 0.0001); previous hospitalization (p < 0.01), and assisted ventilation (p < 0.001). Conclusion: This study revealed that the presence of comorbid disease, acidemia, previous hospitalization and assisted ventilation significantly contributed to mortality in patients with exacerbation of COPD.

Copyright © 2005 S. Karger AG, Basel


 goto top of outline References
  1. Hurd S: The impact of COPD on lung health world wide: Epidemiology and incidence. Chest 2000;117(suppl 2):1s–4s.

    External Resources

  2. NHLB1/WHO Global Initiative for Chronic Obstructive Lung Disease. GOLD 2001, p 1.
  3. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med 1995;152:S77–S120.
  4. BTS guidelines for management of chronic obstructive pulmonary disease. The COPD Guidelines Group of the Standards of Care Committee of the BTS. Thorax 1997;52(suppl):S1–S28.
  5. Roberts CM, Ryland I, Lowe D, Kelly Y, Bucknall CE, Pearson MG: Audit of acute admissions of COPD: Standards of care and management in the hospital setting. Eur Respir J 2000;17:243–349.
  6. Boushy SF, Thompson HK, North LB, Beale AR, Snow TR: Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 1973;108:1373–1383.
  7. Traver GA, Cline MG, Burrows B: Predictors of mortality in chronic obstructive pulmonary disease: A 15-year follow-up study. Am Rev Respir Dis 1979;119:895–902.
  8. Anthonisen NR, Wright EC, Hodgkins JE: Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 1986;133:14–20.
  9. Postma DS, Gimeno F, van der Weele LT, Sluiter HJ: Assessment of ventilatory variables in survival prediction of patients with chronic airflow obstruction: The importance of reversibility. Eur J Respir Dis 1985;67:360–368.
  10. Almagro A, Calbo E, Ochoa de Echaguen A, Barreiro B, Quintana S, Heredia JL, Garau J: Mortality after hospitalization for COPD. Chest 2002;121:1441–1448.
  11. Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA: Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 1995;274:1852–1857.
  12. Connors AF, Dawson NV, Thomas C, Harrell FE Jr, Desbiens N, Fulkerson WJ, Kussin P, Bellamy P, Goldman L, Knaus WA: Outcomes following acute exacerbation of chronic obstructive lung disease. Am J Respir Crit Care Med 1996;154:959–967.
  13. Memon A, Moody PM, Sugathan TN, El-Gerges N, Al-Bustan M, Al-Shattia A, Al-Jazzaf H: Epidemiology of smoking among Kuwaiti adults: Prevalence, characteristics and attitudes. Bull WHO 2000;78:1306–1315.
  14. Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA: Antibiotic therapy in exacerbation of chronic obstructive pulmonary disease. Ann Intern Med 1987;106:196–204.
  15. Balter MS, Hyland RH, Low DE: Recommendations on the management of chronic bronchitis: A practical guide for Canadian Physicians. Can Med Assoc J 1994;157(suppl 10):5–23.
  16. Kanner RE, Renzetti AD, Stannish WM, Barkman HW, Klanber MR: Predictor of survival in subjects with chronic airflow limitation. Am J Med 1983;74:249–255.
  17. Vestbo J, Prescott E, Lange P, Schnohr P, Jensen G: Vital prognosis after hospitalisation for COPD: A study of random population sample. Resp Med 1998;92:772–776.
  18. Dewan NA, Rafique S, Kanwar B, Satpathy H, Ryschan K, Tillotson GS, Niederman MS: Acute exacerbation of COPD: Factors associated with poor treatment outcome. Chest 2000;117:667–671.
  19. Ball P, Harris JM, Lowson D, Tillotson G, Wilson R: Acute infective exacerbations of chronic bronchitis. QJM 1995;88:61–68.
  20. Garcia-Aymerich J, Farrero E, Felez MA, Izquierdo J, Marrades RM, Anto JM: Risk factors for readmission to hospital for a COPD exacerbation: A prospective study. Thorax 2003;58:100–105.
  21. American Thoracic Society: Standards for diagnosis and care of patients with COPD. Am J Respir Crit Care Med 1995;152:S77–S120.
  22. US Surgeon-General 1984: The health consequences of smoking: Chronic obstructive lung disease. DHHS publication No 84–5020 J. Washington, US Department of Health and Human Services, 1984.
  23. Becklake MR: Chronic airflow limitations: Its relationship to work in dusty occupations. Chest 1988;88:608–617.
  24. Larson RK, Barman ML: The familial occurrence of chronic obstructive lung disease. Ann Intern Med 1965;63:1001–1008.
  25. Plank PK, Owen JL, Elliot MW: One year period prevalence study of respiratory acidosis in acute exacerbation of COPD: Implications for the provision of non-invasive ventilation and oxygen administration. Thorax 2000;55:550–554.
  26. Gibson PG, Wlodarczyk JH, Wilson AJ, Sprogis A: Severe exacerbation of chronic obstructive airways disease: Health resource use in general practice and hospital. J Qual Clin Pract 1998;18:125–133.
  27. Thompson WH, Nielsen CP, Carvalho P, Charan NB, Crowley JJ: Controlled trial of oral prednisolone in out-patients with acute COPD exacerbation. Am J Respir Crit Care Med 1996;154:407–412.
  28. Davies L, Angus RM, Calverley PM: Oral corticosteroids in patients admitted to hospital with exacerbation of chronic obstructive pulmonary disease: A prospective randomised controlled trial. Lancet 1999;354:456–460.
  29. Niewoehner DE, Erbland ML, Deupree RH, Collins C, Gross NJ, Light RW, Anderson P, Morgan NA: Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease: Department of Veterans Affairs Co-operative Study Group. N Engl J Med 1999;340:1941–1947.
  30. Kerstjens HAM, Brand PLP, Hughes M: A comparison of bronchodilator therapy with or without inhaled corticosteroid therapy for obstructive airways disease. N Engl J Med 1992;327:1413–1419.
  31. Dompeling E, van Schayck CP, van Grunsven PM, van Herwaarden CL, Akkermans R, Molema J, Folgering H, van Weel C: Slowing the deterioration of asthma and chronic obstructive pulmonary disease observed during bronchodilator therapy by adding inhaled corticosteroids: A 4-year prospective study. Ann Intern Med 1993;118:770–778.
  32. Garcia-Aymerich J, Monso E, Marrades RM, Escarrabill J, Felez MA, Sunyer J, Anto JM: Risk factors for hospitalization for a chronic obstructive pulmonary disease exacerbation. Am J Respir Crit Care Med 2001;164:1002–1007.
  33. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet 1981;i:681–686.
  34. Nocturnal Oxygen Therapy Trial Group: Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: A clinical trial. Ann Intern Med 1980;93:391–398.

    External Resources

  35. Johnson MK, Stevenson RD: Management of an acute exacerbation of COPD: Are we ignoring the evidence? Thorax 2002;57(suppl ii):15–23.
  36. Poole PJ, Black PN: Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease: Systematic review. BMJ 2001;322:1271–1274.
  37. Stey C, Steurer J, Bachmann S, Medici TC, Tramer MR: The effect of oral N-acetylcysteine in chronic bronchitis: A quantitative systematic review. Eur Respir J 2000;16:253–262.
  38. Vincken W, Van Noord JA, Greefhorst APM, Bantje TA, Kesten S, Korducki L, Cornelissen PJ: Dutch/Belgian Tiotropium Study Group: Improved health outcomes in patients with COPD during 1 year’s treatment with tiotropium. Eur Respir J 2002;19:209–216.
  39. Casaburi R, Mahler DA, Jones PW, Wanner A, San Pedro G, ZuWallack RL, Menjoge SS, Serby CW, Witek T Jr: A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J 2002;19:217–224.

 goto top of outline Author Contacts

Prof. B.O. Onadeko
PO Box 29279
Secretariat Post Office
Ibadan, Oyo State (Nigeria)
Tel./Fax +965 234 2 8100556, E-Mail onadeko@hotmail.com


 goto top of outline Article Information

Received: May 6, 2003
Revised: October 30, 2003
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 3, Number of References : 39


 goto top of outline Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 14, No. 1, Year 2005 (Cover Date: January-February 2005)

Journal Editor: F. Al Awadi, Kuwait
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/mpp


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