Influence of Season on Exacerbation Characteristics in Patients With COPD

It also remains unclear if and how FEV: relates to outcomes in AECOPDs, especially in hospitalized patients. Since physicians use risk-stratification tools at time of hospital presentation or early during hospitalization, we did not adjust for potential process-of-care variables that could affect outcomes. Likewise, we could not take use of do-not-resuscitate orders into consideration, nor could we consider the timeliness of initial antibiotic or corticosteroid therapy Viagra Australia Pharmacy.

In conclusion, the BAP-65 system correlates well with the need for MV, hospital mortality, LOS, and cost in patients diagnosed with an AECOPD in a graded fashion. Although no clinical decision rule is infallible, and clinicians must always apply their best judgment, application of the BAP-65 may facilitate accurate risk stratification for both clinical and resource use outcomes, as well as aid in triage decision making in AECOPD.

Background: Patients with COPD experience more frequent exacerbations in the winter. However, little is known about the impact of the seasons on exacerbation characteristics.

Methods: Between November 1, 1995, and November 1, 2009, 307 patients in the London COPD cohort (196 men; age, mean, 68.1 years [SD, 8.4]; FEV^ mean, 1.12 L [SD, 0.46]; FEV^ mean, % predicted, 44.4% [SD, 16.1]) recorded their increase in daily symptoms and time outdoors for a median of 1,021 days (interquartile range [IQR], 631-1,576). Exacerbation was identified as > 2 consecutive days with an increase in two different symptoms.

Results: There were 1,052 exacerbations in the cold seasons (November to February), of which 42.5% and 50.6% were patients who had coryzal and cough symptoms, respectively, compared with 676 exacerbations in the warm seasons (May to August), of which 31.4% and 45.4% were in patients who had coryzal and cough symptoms, respectively (P < .05). The exacerbation recovery period was longer in the cold seasons (10 days; IQR, 6-19) compared with the warm seasons (9 days; IQR, 5-16; P < .005). The decrease in outdoor activity during exacerbation, relative to a pre-exacerbation period (-14 to —8 days), was greater in the cold seasons ( — 0.50 h/d; IQR, —1.1 to 0) than in the warm seasons ( — 0.26 h/d; IQR, —0.88 to 0.18; P = .048). In the cold seasons, 8.4% of exacerbations resulted in patients who were hospitalized, compared with 4.6% of exacerbations in the warm seasons (P = .005).