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Jeong, Lee, Choi, Hwangbo, Kim, Lee, Yoon, Kim, Cha, Park, Jung, and Kim: Comparisons of Clinical Characteristics and Outcomes in COPD Patients Hospitalized with Community-acquired Pneumonia and Acute Exacerbation
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 69(1): 31-38.

Published online: 31 July 2010

DOI: https://doi.org/10.4046/trd.2010.69.1.31

Comparisons of Clinical Characteristics and Outcomes in COPD Patients Hospitalized with Community-acquired Pneumonia and Acute Exacerbation

Seung Wook Jeong, M.D., Jae Hee Lee, M.D., Keum Ju Choi, M.D., Yup Hwangbo, M.D., Yi Young Kim, M.D., Yun Ji Lee, M.D., Won Kyung Yoon, M.D., Min Kim, M.D., Sung Ick Cha, M.D., Jae Yong Park, M.D., Tae Hoon Jung, M.D., Chang Ho Kim, M.D.

Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

Address for correspondence: Chang Ho Kim, M.D. Department of Internal Medicine, Kyungpook National University Hospital, 200, Dongduck-ro, Jung-gu, Daegu 700-721, Korea. Phone: 82-53-420-5537, Fax: 82-53-424-5542, kimch@knu.ac.kr

Received 7 May 2010       Accepted 21 June 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Data comparing the clinical characteristics and outcomes in chronic obstructive pulmonary disease (COPD) patients hospitalized with community-acquired pneumonia (CAP-COPD) and acute exacerbation (AE-COPD) are very limited.

Methods

Eighty episodes of hospitalization in 65 CAP-COPD patients, and 111 episodes of hospitalization in 82 AE-COPD patients were included in this study. The baseline characteristics, clinical presentations, potential bacterial pathogens and clinical outcomes in these patients were retrospectively reviewed and compared.

Results

No significant differences were found between the two groups in parameters related to COPD and co-morbidities, except a higher rate of male among CAP-COPD patients. Clinical presentations by symptoms and laboratory findings on admission were significantly more severe in CAP-COPD patients, who showed higher rates of fever and crepitation, but less wheezing than AE-COPD patients. S. pneumoniae and P. aeruginosae were the most common bacterial pathogens in both groups. With no difference in the overall hospital mortality between both groups, the mean length of hospital stay was significantly longer in the CAP-COPD patients than in AE-COPD patients (15.3 vs. 9.8 days, respectively, p<0.01). Additional analysis on CAP-COPD patients showed that systemic steroid use did not influence the length of hospital stay.

Conclusion

Although there was no significant difference in bacterial pathogens and overall hospital mortality between the two groups, CAP-COPD patients had more severe clinical symptoms and laboratory findings at presentation, and longer hospital stay than AE-COPD patients.

Keywords: Pneumonia, Community-Acquired, Pulmonary Disease, Chronic Obstructive, Disease Exacerbation

Figures and Tables

Table 1
Baseline characteristics of the subjects
trd-69-31-i001

Data are presented as No. (%) or mean±standard deviation. CAP-COPD: community-acquired pneumonia in chronic obstructive pulmonary disease; AE-COPD: acute exacerbation in chronic obstructive pulmonary disease; FEV1: forced expiratory volume in the 1st second; GOLD: Global Initiative for Chronic Obstructive Lung Disease.

Table 2
Clinical features
trd-69-31-i002

Data are presented as No. (%) or mean±standard deviation. CAP-COPD: community-acquired pneumonia in chronic obstructive pulmonary disease; AE-COPD: acute exacerbation in chronic obstructive pulmonary disease; BNP: brain natriuretic peptide.

*In accordance with the classification of Anthonisen et al.6, †Available in 34 episodes with CAP-COPD and 30 episodes with AE-COPD.

Table 3
Potential bacterial pathogens*
trd-69-31-i003

Data are presented as No. (%).

CAP-COPD: community-acquired pneumonia in chronic obstructive pulmonary disease; AE-COPD: acute exacerbation in chronic obstructive pulmonary disease.

*p>0.05 between two groups.

Table 4
Therapeutic modalities and clinical outcomes
trd-69-31-i004

Data are presented as No. (%) or mean±standard deviation. CAP-COPD: community-acquired pneumonia in chronic obstructive pulmonary disease; AE-COPD: acute exacerbation in chronic obstructive pulmonary disease; ICU: intensive care unit; MV: mechanical ventilation.

*No. (%) as against the number of baseline patients (CAP-COPD= 65 and AE-COPD=82) and a patient has one or more episodes.

Table 5
Comparison of clinical data and outcomes according to systemic steroid therapy in patients with community-acquired pneumonia and chronic obstructive pulmonary disease
trd-69-31-i005

Data are presented as No. (%) or mean±standard deviation.

FEV1: forced expiratory volume in the 1st second; BNP: brain natriuretic peptide.

*Available in 28 episodes with steroid (+) and 20 episodes with steroid (-).

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