Study of the outcome of Chronic Obstructive Pulmonary Disease in patients admitted to National Institute for Chest Diseases in Imbaba

Abstract

COPD is largely preventable but is expensive to treat. COPD is one of the most common respiratory problems of adults, is caused in 90% by cigarette smoking. It is an important cause of morbidity and mortality in both high- and low-income countries. While active cigarette smoking is the most important preventable risk factor globally, outdoor and indoor air pollutants can cause or exacerbate COPD. Populations in low-income countries are largely exposed to indoor air pollutants from the combustion of solid fuels, which contributes significantly to the burden of COPD-related diseases, particularly in non-smoking women. Under-recognition and Under-diagnosis of COPD still affect the accuracy of mortality data. However it is clear that COPD is one of the most important causes of death in most countries. The Global Burden of Disease Study projected that COPD, which ranked sixth as a cause of death in 1990, will become the third leading cause of death worldwide by 2020; a newer projection estimated COPD will be the fourth leading cause of death in 2035. Therefore, new GOLD guidelines(GOLD, 2014) suggest the assessment of the severity of COPD not only by FEV1 but also by symptom scoring (e.g., MMRC dyspnea scale or CAT score), and the frequency of acute exacerbations of COPD and these conceptual changes reinforce the importance of a good questionnaire in assessing the severity of COPD in clinical practice. The aim of the work is to study the outcome of COPD patients admitted to The National Institute for Chest diseases in Imbaba during the period from July 2014 to July 2015. In this study 50 patients fulfilled the diagnostic criteria of COPD based on symptoms and spirometery according to Global Initiative for Chronic Obstructive Lung Disease guideline, 2014 was included in current study. All of the studied cases were inpatients. All patients were subjected to: 1- Full medical history and examination. 2- Pre and post bronchodilator spirometric study according to(GOLD, 2014). 3- Questionnaire to detect epidemiology, demographic, clinical characteristic of the patients and available prescription pattern. 4- BODE index was calculated for patients who could do it. Most of the studied cases were males (84%), only (16%) were females, the mean age was 56.88±13.76 yrs. and the mean BMI was 56.88±13.76 Kg/m2. Most of COPD patients came from rural areas (70%) while (30%) came from urban areas; most of the patients had poor housing (78%). Most of the patients had family size ≥5 (78%). Most of studied cases were low educated and Most of them were blue collar either skilled or non-skilled (56%). The majority of the patients in this study were smokers (86 %). The mean age of onset/yrs. was (17.73±7.57) for current smokers while (16.12 ± 5.98) for Ex-smokers.The mean duration of quitting/months was 38.66±56.55 and the Smoking index (P/Y) was (52.94±36.23) for current smokers while (44±23.42) for Ex-smokers. There were 36% shisha and gauza smokers. The mean of stones /session was (3.38±1.78). Cough and Dyspnea were present in all patients, cough was associated with expectoration in all patients (100%) and most of patients had 2nd degree dysnea, while (32%) 3rd degree. All patients were wheezy (100%). Most of the studied cases had comorbidities (60%). IHD was the most frequent comorbidity followed by Diabetes mellitus then Hypertension. Most of the patients had no complication and Respiratory failure was the most frequent complication. (10%) of the studied cases had positive family history and all of them were from the first degree relatives. Most of the studied cases have been followed up by pulmonologist (50%) and (22%) of them by Internal medicine. Most of the studied cases were on empirical treatment (96%). Most of them received ciprofloxacin (50%). and oral methyl xanthine was the most frequent bronchodilator used during exacerbation (90%). Most of the studied cases had received 3rd generation cephalosporin. Most of them received Inhaler combination in the form of Salbutamol/beclomethasone and all of them received mucolytic. There was improvement in spirometry results on discharge, compared with on admission results.

Most of the studied cases (52%) were classified as very severe while (36%) were severe and only (12%) moderate. The mean of 6 min walking test 233.25±51.03 meters while the mean of BMI 25.92±4.72 and of BODE score was 5.47±1.46.Between the studied cases the mean of frequency of exacerbations in the last year was 4.38±1.96. (28%) of them had three times exacerbation in the last year. In most of them the most prominent symptom was dyspnea (86%). Most of the studied cases were previously admitted at hospitals (80%). (78%) were admitted at general ward the mean of number of previous hospitalization at general ward was (3.38±2.17) whereas (26%) were admitted at ICU, the mean was (2.23±1.23). (60%) were previously received O2 therapy. (20%) of the studied cases were on MV. (36%) of the studied casesbecame improved while (34%) was stationary and (30%) deteriorated. (26%) of the studied cases were discharged on domiciliary O2. (16%) of the studied cases were died. Most of them died due to respiratory failure. There was significant correlation between FEV1 and both age and BODE index (on admission & on discharge).But there was non-significant correlation between FEV1 and BMI, smoking index and smoking duration. There was significant correlation between FEV1 and both severity of COPD according to GOLD 2014 based on FEV1 post bronchodilator:(on admission & on discharge)and dyspnea: (on discharge). There was significant correlation between mortality and both place & time of admission, O2 therapy and previous MV. There was statistically significant relationship between incidence of death and number of exacerbations in the last year. Statistically significant higher incidence of death in very severe cases compared to moderate and severe cases. Statistically significant higher incidence of death in cases that's had higher functional outcome score compared to lower scores. Statistically there were significant correlations between deteriorated cases and (previous hospitalization, ICU admission, O2 therapy and previous MV). Non-significant correlation between deteriorated cases and both ward admission and times of admission.Statistically there were significant higher incidence of deterioration in case of increased number of exacerbations in the last year. Statistically significant higher incidence of deteriorated cases in higher BODE index score compared to improved and stationary status on discharge. There was non-significant difference in status on discharge as regard severity of COPD by GOLD. Statistically significant higher incidence of death in cases on O2 therapy (75%) of died cases were on O2 therapy. There was non-significant difference in death regarding other types of hospital treatment. Statistically significant higher incidence of deterioration in cases on O2 therapy; (86.7%) of deteriorated cases was on O2 therapy. Lastly there was non-significant difference in discharge status regarding other types of hospital treatment.