Abstract

Objective: To assess the association between the severity of recent exacerbations and 90-day mortality risk in chronic obstructive pulmonary disease patients (COPD) with acute symptoms, focusing on the impact of the treatment regimen and involving 17 different drug combinations.
Materials and methods: A longitudinal, retrospective analysis was carried out in 495 hospitalized COPD patients aged 40 – 75 years. Patients’ clinical characteristics were recorded and the effects of drug regimens, administered pre and post hospitalization, comprising various combinations of long-acting muscarinic antagonists (LAMA), long-acting beta agonists (LABA), inhaled corticosteroids (ICS), and antibiotics, were compared. A statistical analysis of the primary outcome, 90-day mortality was used to identify patient attributes best predicting mortality.
Results: At discharge, 65% of patients were receiving a 3-drug combination, 33% a 2-drug regimen, and 9% a single-drug therapy. Patients discharged on a 3-drug combination treatment had the lowest 90-day mortality rate (4%) compared to 22% for those treated with single-drug regimens. Multivariate analysis revealed that the risk of death on single-drug therapy was more than 5-fold greater (odds ratio 5.08) than in the case of patients discharged on a multi-drug combination regimen.
Conclusion: Patients treated and discharged from hospital on a multi-drug regimen following recent COPD exacerbations had significantly better 90-day survival than patients discharged on monotherapy. The severity of exacerbations and nature of the pharmacotherapy were the main predictors of mortality and were indicative for the importance of disease assessment and multi-drug treatment strategies.

Author Details

Authors

• Guoxin Wu¹
• Ziyun Guan¹
• Quankun Lv¹
• Yi Ye¹
• Jiacheng He¹
• Jianwen Luo¹
• Yanglin Cai¹
• Zhixin Wu²

Departments

• ¹ Department of Emergency, The Sixth Affiliated Hospital, China School of Medicine, South China University of Technology, and
• ² Department of Intensive Care Unit, Foshan Hospital of TCM, Foshan City, Guangdong Province, China

Address

Ziyun Guan, MD
Department of Emergency
The Sixth Affiliated Hospital
China School of Medicine
South China University of Technology
Foshan City, Guangdong Province, 528200, China
Email: [email protected]

Citation