Investigation of Relationship between Comorbid Factors and Excessive Dynamic Airway Collapse with Frequency of Hospitalization in Frequently Hospitalized COPD Patients

Objective: Frequent hospitalizations in chronic obstructive pulmonary disease (COPD) patiens is defined as 2 or more hospitalizations per year. However, in our clinical practice we observe hospitalizations with 2-3 months intervals in some patients. In this study, we investigated the factors suspected to be related to more frequent hospitalizations in a selected patient population.
Methods: Thirty-four COPD patients hospitalized at least twice per year were included in the study. Patients’ demographics, laboratory findings, physical activity scores, comorbidities and pulmonary function tests were recorded; transthoracic echocardiography and fiberoptic bronchoscopy (FOB) were performed. Patients were categorised into two groups as: Groups were compared in terms of parameters which are thought to increase the frequency of hospitalization.
Results: Twenty eight (82%) of the patients were male. The mean age was 65±8(46-82 years), mean hospitalization number was 3.3±1.3 (2-6). Twelve patients were in Group 1, 22 in Group 2. Older age, lower physical activity, advanced stage, longer duration of the disease, using nebulisator and home-oxygen were significantly higher in Group 2. FEV1 (pred%) was significantly lower in Group 2 (47.9%) than Group 1 (56%). The comorbididities were significantly higher in Group 2 (p=0.014). Pulmonary hypertension (n=11) and heart failure (n=10) were detected only in Group 2 (p=0.003, p=0.006). FOB revealed excessive dynamic airway collapse (EDAC) in 17 (50%) patients; and 16 of them (94%) were in Group 2. Existence of EDAC and lower FEV1 value were found to be independent factors for more frequent hospitalizations.
Conclusion: It is revealed that the presence of EDAC and decrease in FEV1 can increase the frequency of hospitalization in frequently hospitalized COPD patients.