Epidemiological Investigation And Early Warning Index Of Acute Exacerbation In Patients With Chronic Obstructive Pulmonary Disease In Outpatient Department Of Subei Hospital

Aim:1.To investigate the current situation and standardization of diagnosis and treatment of patients with COPD in the outpatient department of Subei Hospital;2.To compare the differences of clinical features between patients with stable COPD and patients with acute exacerbation of COPD;3.To analyze the risk factors for acute exacerbation of COPD,Exploring its early warning effect on AECOPD,providing guidance for the diagnosis and management of AECOPD.Methods:1.From December 2016 to October 2018,a total of 274 patients who were clinically diagnosed as COPD by the chief physician of respiratory department in Subei Hospital were selected to collect their general information,pulmonary function results,and whether or not to perform pulmonary function test,whether the inhaler was used in the past year,and analyze the current status and standardization of diagnosis and treatment of patients with COPD.2.A total of 141 patients with spirometry-defined COPD were divided into 2groups: stable COPD and acute exacerbation of COPD.Clinical data including gender,age,height,weight,smoking history,occupational exposure history,comorbidity,pulmonary function results(FEV1/FVC,FEV1%),the history of exacerbation in the past year,CAT score,mMRC grade and combined COPD assessment groups were collected.We did statistical analyses to screen the risk factors for acute exacerbation of COPD,the ROC curve is used to judge the early warning effect of risk factors for acute exacerbation of COPD,and find the best cut-off point.Results:1.In the outpatient department of Subei Hospital,the composition ratio of patients with COPD was 4.71%,the rate of patients with stable COPD was 1.82%,the rate of patients with acute exacerbation of COPD was 2.89%,and among the 274 patients who were clinically diagnosed as COPD,50.36% of patients were diagnosed as COPD by pulmonary function,14.60% were misdiagnosed as COPD,and 33.94% of patients did not have a pulmonary function test.2.Among the 141 patients with spirometry-defined COPD,men had a higher visit rate(1.89%)than did women(0.53%),13.48% of the patients had pulmonary function tests,13.48% of the patients used inhaler,6.38% of the patients knows that they had the history of COPD.3.Among the 141 patients with a clear diagnosis of COPD through pulmonary function test,74 patients with acute exacerbation of COPD and 67 patients with stable COPD.Univariate analyses showed that there was a significant difference in age and the history of acute exacerbation in the past year between the two groups,the patients with COPD exacerbations has a older age and more frequencies of acute exacerbation than the patients with stable COPD(P<0.05),and the difference was not statistically significant between the two groups in gender,BMI,history of cigarette smoking,occupational exposure history and comorbidity(P>0.05).4.According to the related data of pulmonary function test,the patients with COPD exacerbations was obviously lower than those with stable COPD in FEV1/FVC and FEV1%pred(P<0.001).There was a statistically significant difference between the two groups for the classification of severity of airflow limitation(P<0.001).The classification of severity of airflow limitation in patients with acute exacerbation of COPD was mainly in severe or above(P<0.05),there was no difference in the distribution of mild and moderate between the two groups(P>0.05).5.The scores of CAT and mMRC grade in patients with acute exacerbation of COPD was obviously higher than those with stable COPD(P<0.001).6.The comprehensive evaluation of the severity of the patients in stable COPD was mainly in group A,but acute exacerbation of COPD was mainly in group D(P<0.05).7.In multivariate Logistic analyses,the FEV1/FVC and mMRC grades between patients with stable COPD and patients with acute exacerbation of COPD were no obviously significance(P>0.05),but,CAT scores,the history of acute exacerbation in the past year,FEV1%pred and age were associated significantly with risk of acute exacerbation of COPD(P<0.05).8.The area under the ROC curve of CAT score,FEV1%pred,age were 0.86(95%CI 0.79-0.91,P<0.0001),0.77(95%CI 0.69-0.83,P<0.0001),0.65(95%CI0.57-0.73,P=0.0009)respectively,the difference was statistically significant.The predication of AECOPD by CAT score was greater than that by age(Z=3.93,P=0.001),the early warning of AECOPD by FEV1%pred was greater than that by age(Z=1.98,P=0.0481).There was no significant difference between FEV1%pred and CAT scores in early warning of AECOPD(Z=1.94,P=0.0527).The best cut-off point for CAT score,FEV1%pred and age was13,54.40 and 70 separately.Conclusion:1.In the outpatient department of Subei Hospital,the composition ratio of patients with COPD was 4.71%,only 13.48% of patients with spirometry-defined COPD had previous pulmonary function tests or previous use inhaler,only 6.38% of patients know that they havd COPD,there is still irregularity in the diagnosis and treatment of COPD.The consciousness rate of COPD and the popularity of spirometry are low.There is a long way to use pulmonary function test for early diagnosis,treatment and prevention of COPD.2.Compared to patients with stable COPD,patients with COPD exacerbation have a clinical features of older age,more times of acute exacerbation,higher symptom score,more severe damage of pulmonary function and higher risk.3.CAT score,the history of acute exacerbation in the past year,FEV1%pred and age are the independent risk factors for acute exacerbation of COPD.4.The risk of COPD exacerbation in patients with CAT?13,frequency exacerbation of COPD?2 times in the past year,FEV1%pred?54.40 and age?70 is increased.