Chest
Volume 82, Issue 3, September 1982, Pages 310-314
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The Prognosis of Patients with Chronic Obstructive Pulmonary Disease after Hospitalization for Acute Respiratory Failure

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We followed the course of 36 consecutive patients hospitalized with chronic obstructive pulmonary disease and acute respiratory failure due to exacerbation of chronic bronchitis in order to clarify the prognosis in this common group of patients. All of the patients had spirometric evidence of severe, poorly reversible airflow limitation and all had a similar cause of acute respiratory failure. In addition, all received similar treatment during hospitalization and follow-up. Patients with asthma and pneumonia were excluded by clinical, spirometric, and roentgenographic criteria. Hospital survival was 94 percent, and only one patient required intubation. Two-year survival was 72 percent, and none of the patients died during a readmission for acute respiratory failure. This prognosis is much better than commonly recognized and compares favorably to that of stable outpatients with similar degrees of airflow limitation. An episode of acute respiratory failure, triggered by an exacerbation of chronic bronchitis, does not necessarily alter the prognosis of patients with COPD.

Section snippets

Patient Population

We studied consecutive patients with COPD who were hospitalized at the Seattle Veterans Administration Medical Center between November 1, 1976, and March 1, 1978, with ARF caused by acute bronchitis. COPD was defined as: 1) a history of cough and sputum production during most days for at least three months a year for the two preceding years,8 and 2) severe airflow limitation defined as an FEV1 ≤ 50 percent predicted and FEV1/FVC ≤ 50 percent when the patient was clinically stable either prior

RESULTS

The population sample consisted of 36 patients (Table 1). All were men, and all had a history of heavy cigarette use. None was using home oxygen at the time of hospitalization. The mean arterial pH was within the normal range because some patients were alkalemic while others were acidemic.

Thirty-four patients (94 percent) survived the episode of ARF. Two patients died in the hospital, one because of a seizure which occurred while he was receiving aminophylline and withdrawing from alcohol, and

DISCUSSION

Our population sample was carefully defined so that it would consist of patients with a common clinical problem—an exacerbation of chronic bronchitis which leads to hospitalization for ARF. None of the patients had pneumonia or acute heart failure, and patients with clinical asthma were excluded as carefully as possible. In this group, hospital mortality was low (6 percent), intubation for progressive respiratory failure was performed in only one patient, and the two-year survival rate was 72

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Manuscript received October 29; revision accepted February 22.

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