Objectives: To investigate factors associated with mortality in older patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD).
Design: Prospective cohort study.
Setting: A university teaching hospital in Manchester, UK
Patients: One hundred consecutive patients, aged 60- 98 (mean 73) years admitted with acute exacerbation of COPD.
Method: We collected baseline demographic and physiological data and use of long-term oxygen therapy. Subjects completed prior to discharge the Manchester Respiratory Activities of Daily Living questionnaire (MRADL) assessing physical disability (Yohannes et al. JAGS 2000;48:1496), the Brief Assessment Schedule Depression Cards (BASDEC) a screening questionnaire for depression (Adshead et al., BMJ 1992;305) and the Breathing Problems Questionnaire (BPQ) measuring quality of life (Hyland et al., Qual Life Res 1994;3:245). All subjects were followed prospectively, and survival and mortality data were confirmed by contacting general practitioners and scrutinising hospital notes at 12 months.
Results: The mean (standard deviation) of one second forced expiratory volume (FEV1) was 0.81 (0.3). At 12 months, 36 patients (18 men, aged 61-97 [mean 75] years: 36% of the total) had died. On logistic regression analysis, predictors of mortality were: MRADL score (odds ratio = 0.87, 95% confidence interval = 0.80- 0.94), BASDEC score (odds ratio = 1.13, 95% confidence interval = 1.02-1.26), BPQ score (odds ratio = 1.08, 95% confidence interval = 1.04-1.13) and long term oxygen therapy (odds ratio = 2.72, 95% confidence interval = 2.72 (1.06 – 6.97). Age, gender, smoking status, social class, FEV1 and body mass index were not predictors of mortality.
Conclusion: Quality of life, depressive symptoms, physical disability and use of long-term oxygen therapy are associated with earlier death in older patients with COPD. Further study is worthy of investigation concerning whether alleviation of disability (e.g. pulmonary rehabilitation) is of benefit in this situation.
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