Background and Objective: The aim of this study was to develop and validate two models to estimate the probabilities of frequent exacerbations (more than 1 per year) and admissions for chronic obstructive pulmonary disease (COPD) that can be used in a primary care setting. Methods: Information was obtained in a cross-sectional observational study on ambulatory COPD patients performed in 201 general practices located throughout Spain. The model for admissions included 713 cases, 499 for the developmental sample and 214 in the validation sample; the model for frequent exacerbations included 896 patients, 627 in the developmental sample and 269 in the validation model. Candidate variables to be included in both models were: age, sex, body mass index (BMI), FEV1 as percent predicted [FEV1 (% pred.)] , active smoking, chronic mucus hypersecretion (CMH) and significant comorbidity. Results: The admission model contained 2 readily obtainable variables: comorbidity (OR = 1.97; CI 95% = 1.24–3.14) and FEV1(% pred.) (OR = 0.72; 0.58–0.88, for every 10 units), and well calibrated in developmental and validation samples (goodness-of-fit tests: p = 0.989 and p = 0.720, respectively). The model for frequent exacerbations included 3 variables: age (OR = 1.21; 1.01–1.44; for every 10 years of increasing age), FEV1 (% pred.) (OR = 0.82; 0.70–0.96, for every 10 units) and CMH (OR = 1.54; 1.11–2.14) and also well calibrated (p = 0.411 and p = 0.340 in the developmental and validation samples, respectively). Conclusions: Our results suggest that FEV1 impairment explains part of the risk of frequent exacerbations and hospital admissions. Furthermore, CMH and increasing age are significantly associated with the risk of frequent exacerbations, but severity of exacerbations provoking hospital admissions is associated with the presence of significant comorbidity. These important and easily measurable variables contain valuable information for optimal management of ambulatory patients with COPD.

Keywords:
COPD, Exacerbation, Admission, Risk factors, Mucus hypersecretion, Primary care
1.
Higgins MW, Thom T: Incidence, prevalence, and mortality: Intra- and inter-county differences; inHensley MJ, Saunders NA (eds): Clinical Epidemiology of Chronic Obstructive Pulmonary Disease. New York, Dekker, 1990, pp 23–43.
2.
Lange P, Groth S, Nyboe J, Appleyard M, Mortensen J, Jensen G, et al: Chronic obstructive lung disease in Copenhagen: Cross-sectional epidemiological aspects. J Intern Med 1989;226:25–32.
3.
Bakke PS, Baste V, Hanoa R, Gulsvik A: Prevalence of obstructive lung disease in a general population: Relation to occupational title and exposure to some airbone agents. Thorax 1991;46:863–870.
4.
Brotons B, Pérez JA, Sánchez-Toril F, Soriano S, Hernández J, Belenguer JF: Prevalencia de la enfermedad obstructiva crónica y el asma. Estudio transversal (English abstract). Arch Bronconeumol 1994;30:149–152.
5.
Sobradillo V, Miravitlles M, Jiménez CA, Gabriel R, Viejo JL, Masa JF, et al: Estudio IBERPOC en España: Prevalencia de síntomas respiratorios habituales y de limitación crónica al flujo aéreo (English abstract). Arch Bronconeumol 1999;35:159–166.
6.
Seemungal TAR, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA: Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1418–1422.
7.
Burrows B, Earle RH: Course and prognosis of chronic obstructive lung disease: A prospective study of 200 patients. N Engl J Med 1969;280:397–404.
8.
Murata GH, Gorby MS, Kapsner CO, Chick TW, Halperin AK: A multivariate model for the prediction of relapse after outpatient treatment of decompensated chronic obstructive pulmonary disease. Arch Intern Med 1992;152:73–77.
9.
Loukides S, Polyzogopoulos D: The effect of diabetes mellitus on the outcome of patients with chronic obstructive pulmonary disease exacerbated due to respiratory infections. Respiration 1996;63:170–173.
10.
Osman LM, Godden DJ, Friend JAR, Legge JS, Douglas JG: Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax 1997;52:67–71.
11.
Ball P, Harris JM, Lowson D, Tillotson G, Wilson R: Acute infective exacerbations of chronic bronchitis. Q J Med 1995;88:61–68.
12.
Fuso L, Antonelli Incalzi R, Pistelli R, Muzzolon R, Valente S, Pagliari G, et al: Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 1995;98:272–277.
13.
Vilkman S, Keistinen T, Tuuponen T, Kivelú SL: Survival and cause of death among elderly chronic obstructive pulmonary disease patients after first admission to hospital. Respiration 1997;64:281–284.
14.
Connors AF Jr, Dawson NV, Thomas C, Harrel FE Jr, Desbiens N, Fulkerson WJ, et al: Outcomes following acute exacerbation of severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;154:959–967.
15.
Antonelli Incalzi R, Fuso L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, et al: Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997;10:2794–2800.
16.
Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E: Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;159:158–164.
17.
Miravitlles M, Mayordomo C, Artés M, Sánchez-Agudo L, Nicolau F, Segú JL on behalf of the EOLO Group: Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. Respir Med 1999;93:173–179.
18.
British Thoracic Society: BTS guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997;52(suppl 5):s4–s28.
19.
Roca J, Sanchis J, Agustí-Vidal A, Segarra F, Navajas D, Rodriguez-Roisín R, et al: Spirometric reference values from a Mediterranean population. Bull Eur Physiopathol Respir 1986; 22:217–224.
20.
Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GKM, Nelson NA: Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987;106:196–204.
21.
Hosmer DW, Lemeshow S: Applied Logistic Regression. New York, John Wiley, 1989.
22.
Prescott E, Lange P, Vestbo J: Chronic mucus hypersecretion in COPD and death from pulmonary infection. Eur Respir J 1995;8:1333–1338.
23.
Hanley JA, McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29–36.
24.
Fabbri L, Beghé B, Caramori G, Papi A, Saetta M: Similarities and discrepancies between exacerbations of asthma and chronic obstructive pulmonary disease. Thorax 1998;53:803–808.
25.
Ferrer M, Alonso J, Morera J, Marrades RM, Khalaf A, Aguar MC, et al: Chronic obstructive pulmonary disease stage and health-related quality of life. Ann Intern Med 1997;127:1072–1079.
26.
Lange P, Nyboe J, Appleyard M, Jensen G, Schnohr P: Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes. Thorax 1990;45:579–585.
27.
Burrows B, Bloom JW, Traver GA, Cline MG: The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med 1987;317:1309–1314.
28.
Miravitlles M, Espinosa C, Fernández-Laso E, Martos JA, Maldonado JA, Gallego M, and Study Group of Bacterial Infection in COPD: Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Chest 1999;116:40–46.
© 2000 S. Karger AG, Basel
2000
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