A study on COPD EXACERBATIONS treated in Emergency Department of Fondazione IRCCS Policlinico San Matteo of Pavia - year 2018

COPD (Chronic Obstructive Pulmonary Disease) is a common lung pathology in the middle aged and elderly population. Signs and symptoms, exposure to risk factors and spirometry are essential in making the diagnosis of COPD. Dyspnoea is the cardinal symptom and around 30% of patients have chronic cough too with/without sputum production. The main risk factor is smoking. COPD is characterized by an obstructive pattern at spirometry with a post bronchodilator FEV1/FVC < 0.70 and is a chronic progressive disease since dyspnoea and airway obstruction revealed at spirometry are persistent and tend to progress and worsen over time. During disease course, patients can undergo acute exacerbations defined as “acute worsening of respiratory symptoms that results in an additional therapy”. Our study was conducted on 173 patients who were examined in the Emergency Department of Fondazione IRCCS Policlinico San Matteo of Pavia, for COPD Exacerbations during the year 2018. We collected data about each patient, including information about pathological and pharmacological anamnesis, and total number of Emergency Department accesses during the years 2018 and 2019. As study objective, we evaluated the impact of comorbidities on COPD Exacerbations in terms of outcome (hospitalization/discharge) and exacerbation frequency. Heart Disease (coronary heart disease, heart failure, valvular heart disease, hypertensive heart disease), Systemic Hypertension, Arrhythmias, Chronic Kidney Disease (CKD), Diabetes Mellitus are the comorbidities we took into consideration in the analysis. Results: In the first part of the analysis, we evaluated with a Logistic Regression which comorbidities significantly affect ratio of patients hospitalized/not hospitalized in 2018 for COPD Exacerbations. In the second part, with the same statistical method, we studied association between comorbidities and Emergency Department new accesses (yes/no) for COPD Exacerbation, calculated on years 2018 and 2019. Our study has found a high comorbidity prevalence, in fact 77% of the patients we enrolled have ≥ 1 among studied comorbidities. Heart Disease (p value=0.017; OR=2.55; 95% CI for odds ratio: 1.19- 5.57) is the only comorbidity that significantly increases likelihood of hospitalization for COPD Exacerbations. Hypertension, CKD, Arrhythmias slightly increase likelihood of hospitalization, but results are far from statistical significance. In our study Diabetes does not appear to be associated with hospitalization. Heart Disease (p=0.02; OR=2.54; 95% CI OR=1.16-5.71) and Diabetes (p= 0.038; OR= 2.50; 95% CI OR= 1.06 – 6.1) significantly increase likelihood of ER new accesses for a COPD Exacerbation in a time span of two years. Hypertension (p=0.069; OR=2.11; 95% CI OR=0.94-4.82) has a trend to increase likelihood of new accesses, but it is still not statistically significant for alfa=0.05. Impact of CKD and Arrhythmias on new accesses was found to be far from statistical significance. Conclusion: We have found that Heart Diseases significantly increase both likelihood of hospitalization and Emergency Department new accesses in a time span of two years for COPD Exacerbations. Diabetes has not impacted hospitalization in our sample but has turned out to be a statistically significant driver of Emergency Department new accesses. Hypertension showed a trend to increase likelihood of new accesses, close to significance. The impact of the other studied comorbidities, CKD and Arrhythmias, was found to be weaker and far from statistical significance. The importance of this study was to look for new knowledge on the correlation between COPD and comorbidities and has left large space to better delineate if COPD is an independent clinical entity or is in a continuum with comorbidities such as CVD, CKD, Diabetes.