Morbidity and mortality among people with COPD occurs most often in the context of exacerbations. A study identified an approximately 50% 5-year mortality following hospitalisation for COPD exacerbation.[155]Hoogendoorn M, Hoogenveen RT, Rutten-van Mölken MP, et al. Case fatality of COPD exacerbations: a meta-analysis and statistical modelling approach. Eur Respir J. 2011;37:508-515.
http://erj.ersjournals.com/content/37/3/508.long
http://www.ncbi.nlm.nih.gov/pubmed/20595157?tool=bestpractice.com
Re-hospitalisation and/or mortality have been associated with lower FEV1, higher PaCO2, lower PaO2, lower body mass index, older age, comorbidities, and low physical activity levels.[156]Breen D, Churches T, Hawker F, et al. Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study. Thorax. 2002 Jan;57(1):29-33.
https://thorax.bmj.com/content/57/1/29.long
http://www.ncbi.nlm.nih.gov/pubmed/11809986?tool=bestpractice.com
[157]Dewan NA, Rafique S, Kanwar B, et al. Acute exacerbation of COPD: factors associated with poor treatment outcome. Chest. 2000 Mar;117(3):662-71.
http://www.ncbi.nlm.nih.gov/pubmed/10712989?tool=bestpractice.com
[158]Gunen H, Hacievliyagil SS, Kosar F, et al. Factors affecting survival of hospitalised patients with COPD. Eur Respir J. 2005 Aug;26(2):234-41.
http://erj.ersjournals.com/content/26/2/234.full
http://www.ncbi.nlm.nih.gov/pubmed/16055870?tool=bestpractice.com
[159]Garcia-Aymerich J, Farrero E, Felez MA, et al. Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax. 2003 Feb;58(2):100-5.
https://thorax.bmj.com/content/58/2/100.long
http://www.ncbi.nlm.nih.gov/pubmed/12554887?tool=bestpractice.com
[160]Garcia-Aymerich J, Lange P, Benet M, et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006 Sep;61(9):772-8.
https://thorax.bmj.com/content/61/9/772.long
http://www.ncbi.nlm.nih.gov/pubmed/16738033?tool=bestpractice.com
[161]Piquet J, Chavaillon JM, David P, et al. High-risk patients following hospitalisation for an acute exacerbation of COPD. Eur Respir J. 2013 Oct;42(4):946-55.
https://erj.ersjournals.com/content/42/4/946.long
http://www.ncbi.nlm.nih.gov/pubmed/23349446?tool=bestpractice.com
[162]Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2013 Apr;10(2):81-9.
https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201208-043OC
http://www.ncbi.nlm.nih.gov/pubmed/23607835?tool=bestpractice.com
The multidimensional CODEX (comorbidity, obstruction, dyspnoea, previous severe exacerbations) index can predict readmission and survival at 3 months and 1 year after hospitalisation for COPD exacerbation.[163]Almagro P, Soriano JB, Cabrera FJ, et al. Short- and medium-term prognosis in patients hospitalized for COPD exacerbation: the CODEX index. Chest. 2014 May;145(5):972-80.
http://www.ncbi.nlm.nih.gov/pubmed/24077342?tool=bestpractice.com
Acute exacerbations range from very mild to severe and life-threatening.
Patients who have had a significant exacerbation of COPD may not always recover back to their pre-illness functional status. Pulmonary rehabilitation may be required to improve exercise tolerance, physical ability, and quality of life after discharge.
