Clinical features of frequent acute exacerbations of chronic obstructive pulmonary disease in elderly patients / 中华老年医学杂志

ABSTRACT

Objective:To investigate the clinical features of frequent acute exacerbations of chronic obstructive pulmonary disease(COPD)in the elderly.Methods:A total of 93 elderly patients with stable COPD who were followed up in Bethune Hospital Affiliated to Shanxi Medical University from August 2015 to September 2016 were retrospectively analyzed.They were divided into the frequent acute exacerbation group(n=45)and the non-frequent acute exacerbation group(n=48). Data on the body mass index(BMI), lung function, the smoking index(package year), the respiratory status questionnaire and serum creatinine levels were collected.Logistic regression analysis was used to analyze the influencing factors for the frequency of acute exacerbations of COPD in elderly patients.Results:The BMI was lower [19.59(18.08-23.50)kg/m 2vs. 23.36(21.14-25.46)kg/m 2, Z=8.898, P=0.003], while scores of the modified Medical Research Council(mMRC)dyspnea scale, COPD Assessment Test(CAT)and smoking index were higher [3.00(1.00-3.00) vs. 1.00(0.00-1.00), 15.00(8.50-17.50) vs.10.00(6.00-13.75), 60.00(30.00-80.00)package years vs.37.50(3.75-60.00)package years, Z=17.671, 7.318 and 6.589, P<0.001, 0.007 and 0.010]in the frequent acute exacerbation group than in the non-frequent acute exacerbation group.The glomerular filtration rate(GFR)and percentage of predicted forced expiratory volume in the first second were lower in the frequent acute exacerbation group than in the non-frequent acute exacerbation group [105.13(89.84-114.69)ml·min -1·1.73m -2vs.121.74(93.89-142.02)ml·min -1·1.73m -2, 40.10(31.40-56.00)% vs.70.65(47.36-85.36)%, Z=6.071 and 17.814, P=0.014 and<0.001]. Logistic regression analysis showed that the odds ratios( OR)with 95% confidence interval(95% CI)of the smoking index and GFR were 1.025(1.006-1.044)and 0.957(0.927-0.995)( P=0.009 and 0.025), respectively, indicating that with the increase of smoking index and the decrease of GFR, the risk of frequent exacerbations of COPD was increased. Conclusions:There are phenotypic differences between elderly COPD patients with frequent acute exacerbations and without frequent acute exacerbations.Elderly COPD patients with frequent acute exacerbations have a lower BMI index, a higher smoking index, more clinical symptoms, worse pulmonary function, and are prone to early kidney injury.