There is a broad spectrum of severity of disease encompassed by people with COPD. Likewise, acute exacerbations range from very mild to severe and life-threatening. Morbidity and mortality among people with COPD occurs most often in the context of exacerbations. Older studies have estimated mortality rates of 4% to 30% among patients hospitalized for acute exacerbations. A study based on data available from the 1996 Nationwide Inpatient Sample (Agency for Healthcare Research and Quality, Rockville, MD) found in-hospital mortality for people with an acute exacerbation to be 2.5% overall.[266] In this study, the median duration of hospitalization was 5 days and 70% of patients were discharged to home without additional in-home health services. Patients who died during hospitalization were shown to be older, had greater levels of underlying comorbidities, and were hospitalized for longer periods. Not surprisingly, a greater rate of mortality was shown for patients who were mechanically ventilated compared with those who were not (28% versus 1.7%). Another study identified an approximately 50% 5-year mortality following hospitalization for COPD exacerbation.[267] Rehospitalization and/or mortality have been associated with lower FEV1, higher partial pressure of carbon dioxide, lower partial pressure of oxygen, greater APACHE II score, lower BMI, older age, comorbidities, and low physical activity levels.[221][268][269][270][271][272][273] The multidimensional CODEX (comorbidity, obstruction, dyspnea, previous severe exacerbations) index can predict readmission and survival at 3 months and 1 year after hospitalization for COPD exacerbation.[274]

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