Risk factors for poor outcomes in patients with acute COPD exacerbations
Risk factors for poor outcomes in patients with acute COPD exacerbations
Comorbid conditions (especially heart failure or ischemic heart disease)
Severe underlying COPD (eg, FEV1 <50%)
Frequent exacerbations of COPD (ie, ≥2 exacerbations per year)
Hospitalization for an exacerbation within the past 3 months
Receipt of continuous supplemental oxygen
Age ≥65 years*
Patients with greater underlying COPD severity are at higher risk for poor outcomes if initial antibiotic therapy is inadequate. We thus use a broader empiric regimen for such patients.
COPD: chronic obstructive pulmonary disease; FEV1: forced expiratory volume in 1 second. * Older age (eg, age ≥65 years) is also associated with poorer outcomes and/or risk of infection with drug-resistant pathogens. While not a strict indication for broadening antibiotic therapy, we consider older age as additive to the risk factors listed above.
References:
Balter MS, La Forge J, Low DE, et al. Canadian guidelines for the management of acute exacerbations of chronic bronchitis. Can Respir J 2003; 10 Suppl B:3B.
Miravitlles M, Murio C, Guerrero T. Factors associated with relapse after ambulatory treatment of acute exacerbations of chronic bronchitis. DAFNE Study Group. Eur Respir J 2001; 17:928.
Wilson R, Jones P, Schaberg T, et al. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Thorax 2006; 61:337.
Garcia-Vidal C, Almagro P, Romaní V, et al. Pseudomonas aeruginosa in patients hospitalised for COPD exacerbation: a prospective study. Eur Respir J 2009; 34:1072.
Parameswaran GI, Sethi S. Pseudomonas infection in chronic obstructive pulmonary disease. Future Microbiol 2012; 7:1129.
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