Chronic obstructive pulmonary disease: significance of risk factors for frequent exacerbations requiring hospitalization

Abstract

Aim. Identification of risk factors for readmissions associated with an exacerbation of chronic obstructive pulmonary disease (COPD) followed by evaluation of quality of the medical care in the outpatient and hospital settings.

Methods. A retrospective analysis of the medical records of patients with an exacerbation of chronic obstructive pulmonary disease admitted to the multidisciplinary hospitals in Kazan from January 1, 2015 to December 31, 2018, was.

Results. The identified risk factors for readmission were male gender (relative risk (RR) 3.49; 95% confidence interval (CI) 1.45 – 8.43; p < 0.05), age over 70 years (RR 1.21; 95% CI 0.74 – 1.86; p < 0.05), smoking experience more than 40 years (RR 1.6; 95% CI 0.87 – 3.0; p < 0.05), duration of COPD at least 10 years (RR 3.48; 95% CI 2.27 – 5.34; p < 0.05), the presence of three or more concomitant diseases (RR 2.0; 95% CI 1.23 – 3.4; p < 0.05). The most significant reasons for readmissions were nonadherence in the outpatient settings, as well as defects in the therapy that was provided in the hospital and prescribed upon discharge.

Conclusion. The identified risk factors are non-modifiable in most cases, so optimizing treatment and monitoring patient adherence are of paramount importance. Also, more attention should be paid to nonpharmacological treatment in the form of maintaining physical activity, early smoking cessation and psychological rehabilitation. The revealed defects of the quality of medical care for patients with severe exacerbations requiring repeated hospitalizations indicate the need to intensify the implementation of the federal clinical guidelines on chronic obstructive pulmonary disease in the real clinical practice.