ABSTRACT
Early on in the disease a patient may present with increased breathlessness accompanied by cough and purulent sputum but may not need hospital admission (Figure 6.1).
Later in the progression of the disease the patients often rapidly go into acute respiratory failure, representing a significant burden on health-care systems. Hospital mortality of patients admitted for an exacerbation of COPD is approximately 10 per cent and the long-term outlook is very poor. Most studies have shown that patients needing hospital admissions longer than 10 days have a 1-year mortality rate approaching 40 per cent and patients older than 65 years experiencing these events can have mortality rates up to 60 per cent. A retrospective audit of patients admitted to UK hospitals with an exacerbation of COPD showed that 34 per cent were re-admitted and 14 per cent were dead within 3 months. Factors that increase risk of death or readmission are more than three previous admissions, forced expiratory volume in 1 second (FEV1) less than 30 per cent predicted, PaO2 (arterial partial pressure of oxygen) less than 7.3 kPa and previously housebound patients.
