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

Objective: "Frequent hospitalization" is defined as at least 2 hospitalizations per year in chronic obstructive pulmonary disease (COPD). However, we witness hospitalizations at 2-3-month intervals in some patients in our clinical practice. In our study, the factors considered to be associated with frequent hospitalizations were investigated in a selected patient group. Methods: Thirty-four COPD patients being hospitalized at least twice per year were included in the study. The patients' demographic features, laboratory findings, physical activity scores, comorbidities, and respiratory functions were recorded. They underwent transthoracic echocardiography and fiberoptic bronchoscopy (FOB). The patients were categorized as Group 1 (patients hospitalized twice per year) and Group 2 (patients hospitalized more than twice per year). These groups were compared with regard to parameters considered to increase the frequency of hospitalization. Results: Twenty-eight (82%) of the patients were male. The mean age was 65±8 (46-82) years, and the mean hospitalization number was 3.3±1.3 (2-6). There were 12 patients in Group 1 and 22 patients in Group 2. The rates of being in advanced age, showing lower physical activity, being in advanced stage, having disease for more than 10 years, and using a nebulizer and oxygen at home were found to be significantly higher in Group 2 than in Group 1. FEV1 (expected %) level was 47.9% in Group 2, while it was 56% in Group 1 (p=0.003). The number of comorbidities was approximately 1.5 in Group 1 and 2.7 in Group 2 (p=0.014). Pulmonary hypertension (n=11) and heart failure (n=10) were identified only in Group 2 (p=0.003, p=0.006). Excessive dynamic airway collapse (EDAC) was detected in 17 (50%) patients through FOB, and 16 of them were in Group 2. Logistic regression analysis revealed the existence of EDAC and a low level of FEV1 (expected %) as the independent factors that affected the number of hospitalizations.


Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 1608-13. [CrossRef]

Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obst- ructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: 1418- 22. [CrossRef]

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease updated 2010 (

Wright CD. Tracheomalacia. Chest Surg Clin N Am 2003; 13: 349-57. [CrossRef]

Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and trache- obronchomalacia in children and adults: an in-depth review. Chest 2005; 127: 984-1005. [CrossRef]

Greene R. "Saber-sheath" trachea: relation to chronic obstructive pulmo- nary disease. AJR Am J Roentgenol 1978; 130: 441-5. [CrossRef]

Nuutinen J, Leinonen A. Acquired tracheobronchomalacia. A cineradiog- raphic study with bronchologic correlations. Ann Clin Res 1977; 9: 365-8.

Ernst A, Majid A, Feller-Kopman D, Guerrero J, Boiselle P, Loring SH, et al. Airway stabilization with silicone stents for treating adult tracheobron- chomalacia: a prospective observational study. Chest 2007; 132: 609-16. [CrossRef]

Palombini BC, Villanova CA, Araujo E, Gastal OL, Alt DC, Stolz DP, et al. A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Chest 1999; 116: 279-84. [CrossRef]

Jokinen K, Palva T, Sutinen S, Nuutinen J. Acquired tracheobronchomala- cia. Ann Clin Res 1977; 9: 52-7.

Ikeda S, Hanawa T, Konishi T, Adachi M, Sawai S, Chiba W et al. Diagnosis, incidence, clinicopathology and surgical treatment of acquired trache- obronchomalacia. Nihon Kyobu Shikkan Gakkai Zasshi 1992; 30: 1028-35.

Jokinen K, Palva T, Nuutinen J. Chronic bronchitis. A bronchologic evalu- ation. ORL J Otorhinolaryngol Relat Spec 1976; 38: 178-86. [CrossRef]

Kandaswamy C, Balasubramanian V. Review of adult tracheomalacia and its relationship with chronic obstructive pulmonary disease. Curr Opin Pulm Med 2009; 15: 113-9. [CrossRef]

Groenewegen KH, Schols AM, Wouters EF. Mortality and Mortality-Rela- ted Factors After Hospitalisation for Acute Exacerbation of COPD. Chest 2003; 124: 459-67. [CrossRef]

Almagro P, Cabrera FJ, Diez J, Boixeda R, Ortiz MBA, Murio C, et al. Co- morbidities and Short-term Prognosis in Patients Hospitalized for Acute Exacerbation of COPD. Chest 2012; 142: 1126-33. [CrossRef]

Bahadori K, FitzGerald JM, Levy RD, Fera T, Swiston J. Risk factors and out- comes associated with chronic obstructive pulmonary disease exacerba- tions requiring hospitalization. Can Respir J 2009; 16: 43-9.

WHO expert consultation. Appropriate body-mass index for Asian popu- lations and its implications for policy and intervention strategies. Lancet 2004; 363: 157-63. [CrossRef]

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guideli- nes. Circulation 2005; 112: 154-235.

Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Eur Respir J 2008; 32: 1371-85. [CrossRef]

Zigmond AS, Snaith PR. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-70. [CrossRef]

Aydemir Ö, Güvenir T, Küey L, Kültür S. Validity and reliability of the Tur- kish version of hospital anxiety and depression scale. Türk Psikiyatri Der- gisi 1997; 8: 280-7.

Scoring Protocol, 2005. Available from:

Savcı S, Öztürk M, Arıkan H. Physical activity levels of university students. Türk Kardiyoloji Arşivi 2006; 34: 166-72.

Fan VS, Curtis R, Tu SP, McDonell MB, Fihn SD. Using quality of life to pre- dict hospitalization and mortality in patients with obstructive lung dise- ases. Chest 2002; 122: 429-36. [CrossRef]

Osman IM, Godden DJ, Friend JA, Legge JS, Douglas JG. Quality of life and hospital re-admission in patients with chronic obstructive pulmo- nary disease. Thorax 1997; 52: 67-71. [CrossRef]

Garcia-Sanz MT, Pol-Balado C, Abellas C, Canvie-Gomez JC, Anton-San- martin D, Gonzalez-Barcala FJ. Factors associated with hospital admissi- on in patients reaching the emergency department with COPD exacer- bation. Multidiscip Respir Med 2012; 7: 6. [CrossRef]

Ozyilmaz E, Kokturk N, Teksut G, Tatlicioglu T. Unsuspected risk factors of frequent exacerbations requiring hospital admission in chronic obstruc- tive pulmonary disease. Int J Clin Pract 2013; 67: 691-7. [CrossRef]

Cao Z, Ong KC, Eng P, Tan WC, Ng TP. Frequent hospital readmissions for acute exacerbation of COPD and their associated factors. Respirology 2006; 11: 188-95. [CrossRef]

Garcia-Aymerich J, Farrero E, Felez MA, Izquierdo J, Marrades RM, Anto JM, et al. Risk factors of readmission to hospital for a COPD exacerbation: A prospective study. Thorax 2003; 58: 100-5. [CrossRef]

Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159: 158-64. [CrossRef]

Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P, Salcedo E, Na- varro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60: 925-31. [CrossRef]

Pouw EM, Ten Velde GP, Croonen BH, Kester AD, Schols AM, Wouters EF. Early non-elective readmission for chronic obstructive pulmonary disea- se is associated with weight loss. Clin Nutr 2000; 19: 95-9. [CrossRef]

Groenewegen KH, Schols AM, Wouters EFM. Mortality and Mortality-Re- lated Factors After Hospitalization for Acute Exacerbation of COPD. Chest 2003; 124: 459-67.[CrossRef]

McEvoy CE, Niewoehner DE. Adverse effects of corticosteroid therapy for COPD: A critical review. Chest 1997; 111: 732-43. [CrossRef]

Tsai CL, Clark S, Cydulka RK, Rowe BH, Camargo CA Jr. Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation. Acad Emerg Med 2007; 14: 6-14. [CrossRef]

Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009; 33: 1165-85. [CrossRef]

Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: Role of comorbidities. Eur Respir J 2006; 28: 1245-57. [CrossRef]

Taşçı C, Arık D, Uçar E, Özkan M, Tozkoparan E, Bilgiç H. Retrospective evaluation of hospitalized COPD patients (One-year Follow-up).J Clin Anal Med 2011; 2: 4-6. [CrossRef]

Süreyyapaşa Chest Diseases and Chest Surgery Training and Research Hospital, Statistics for the year 2010.

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