COPD exacerbation: cardiopulmonary disease increased the risk of hospital admission or revisiting primary care physicians

Clinical bottom line (level 1b)

  1. One in eight patients visiting a primary care physician with an acute exacerbation of COPD returned with the same problem within 4 weeks.
  2. The risk of reattending was increased with
    • previous cardiopulmonary disease
    • more than 4 episodes of chest infection within the previous year
  3. One in fifty will be admitted to hospital in the next 4 weeks.
  4. The risk is increased with previous cardiopulmonary disease.
Ball et al: Q J Med 1995; 88 : 61-68
Expires June 2004

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: 127 general practitioners, general practices, UK

471 patients (aged 31 to 95; mean 68, 56% male) with acute exacerbations of COPD

Excluded if
  • moved away from practice area during 4 weeks of study


Factors studied:
  • clinical features, history of cardiopulmonary disease,chest infection, daily sputum production, age, sex, smoking history
  • cardiopulmonary disease
  • > 4 chest infections in last year
  • cardiopulmonary disease



89.4% followed for 4 weeks

Outcomes studied:
  • return visit with same respiratory problem
  • admitted to hospital

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    return visit with same respiratory problem 4 weeks 56/423 13%
    (10% to 17%)    		 8
    (6 to 10)
    admitted to hospital 4 weeks 9/423 2.1%
    (0.8% to 3.5%)    		 47
    (29 to 130)

    prognostic factor for
    return visit with same respiratory problem     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    cardiopulmonary disease 4 weeks 56/423
    (13%)     		2.30
    (1.30 to 4.10)     		8
    (4 to 30)
    > 4 chest infections in last year 4 weeks 56/423
    (13%)     		2.11
    (4.23 to )     		9
    (4 to 180)

    prognostic factor for
    admitted to hospital     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    cardiopulmonary disease 4 weeks 9/423
    (2.1%)     		8.89
    (1.73 to 45.6)     		7
    (2 to 67)

      Citation

      1. Ball P, Harris JM, Lowson D, et al: acute infective exacerbations of chronic bronchitis. Q J Med 1995; 88 : 61-68
      Search Terms: from reference list of AHRQ review
      Contributor: Chris Ball, June 2002
      Reviewer:

      Clinical Question.
      Patient COPD exacerbation
      Intervention or Exposure cardiopulmonary disease, chest infections
      Outcome reattending primary care physician or admission to hospital