Abstract |
Acute exacerbation is an important event of COPD as it causes significant disability and mortality. Especially repeated hospitalisation of patients with acute exacerbation has been associated with reduce quality of life and excessive hospitalisation cost. Chronic Obstructive Pulmonary Disease causes significant functional limitations that translate into enormous economic and societal burden. Study Aim: To describe the profile and selected outcomes of Chronic Obstructive Pulmonary Disease (COPD) patients admitted with acute exacerbation to hospitals in the northern suburbs of the Western Cape. Study design: A multicenter retrospective descriptive single subject design was used. Method: Patients admitted with the diagnosis of COPD with acute exacerbation in the time period 01June 2004-01June 2005 were followed up retrospectively for a period of 12 months. The demographics, medical condition on admission and past presentation of acute exacerbation, length of stay in hospital and the number of readmissions for acute exacerbation in the 12 month period were collected and recorded on a self designed data capture sheet. Results: One hundred and seventy eight patients were admitted with acute exacerbation at the three hospitals. The mean age of the patients were 63 (±11.73), more males than females (103: 75) were admitted. Subjects spent a mean of 5.67 (±6.55), days in hospital with every admission and admission frequency of up to eight periods were recorded. Of the n=178 admitted, 56% had one admission and 44% had 2 or more admissions in the study year. This resulted in a total of 338 hospital admissions with the 78 subjects responsible for the majority of admissions (238) Subjects presenting with two or more co-morbidities had a significantly greater risk of multiple re admissions. Subjects with three or more admissions had two or more co morbidities (p=0.001), comparatively those with one admission had only one co morbidity. Congestive cardiac failure (p=0.01) as well as the lack of Long Term Oxygen Therapy p=0.017) were associated with increase risk of three or more admissions. Conclusion: Patients admitted with acute exacerbation to the hospitals where the study was conducted presented with an age ranging from 30-95 years. Patients with 2 or more admissions experience up to eight readmissions episodes in the study year. This is a cause of concern in respect of the burden of disease on especially the younger economically viable South African population. In the current study factors that influenced readmission were the presence of two or more co morbid diseases, specifically the presence of congestive cardiac failure as well as the lack of LTOT. Interventions including a pulmonary rehabilitation programme post discharge should be aimed at decreasing frequency of hospitalisation especially in those patients who are a risk of readmission |