COPD Hospitalization Outcomes Affected by Obesity

Patients diagnosed with obesity and hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (COPD) may be associated with longer hospitalization and the use of both noninvasive positive pressure ventilation and invasive mechanical ventilation, according to a study published in the Annals of the American Thoracic Society. 

Researchers performed a population-based retrospective cohort study of 187,647 patients in 7 US states (Arkansas, Florida, Iowa, Nebraska, New York, Utah, and Washington) hospitalized for an acute exacerbation of COPD, to examine the association of obesity with the use of noninvasive positive pressure ventilation, use of invasive mechanical ventilation, length of hospital stay, and in-hospital mortality.

Study results showed patients diagnosed with obesity were found to have increased use of both noninvasive positive pressure ventilation and invasive mechanical ventilation during hospitalization (12.0% vs 6.5%; adjusted odds ratio [aOR], 1.86 [95% CI, 1.77-1.95], P <.001, and 3.5% vs 2.8%; aOR, 1.13 [95% CI, 1.04-1.22], P =.003, respectively). In addition, patients diagnosed with obesity were more likely to have a length of hospital stay ≥4 days (57.9% vs 50.3%; aOR, 1.37 [95% CI, 1.33-1.41], P <.001).

Of note, in-hospital mortality was noted to be lower in patients with obesity compared with patients who were not diagnosed with obesity before adjusting with potential confounders (0.9% vs 1.4%; unadjusted OR, 0.63 [95% CI, 0.56-0.72], P <.001), but was found to not be statistically significant after adjustment (aOR, 0.86; [95% CI, 0.75-1.00] P =.06).

Investigators concluded that in “adults hospitalized with an acute exacerbation of COPD, obesity was associated with increased use of noninvasive and invasive ventilation, increased length of stay, but was not associated with increased in-hospital mortality.” 

Clinicians should be encouraged to use preventive and therapeutic approaches, such as weight reduction, in patients with COPD to prevent the use of these invasive approaches during hospitalization for an acute exacerbation of COPD.

Reference

Goto T, Hirayama A, Faridi M, Camargo C, Hasegawa K.  Obesity and severity of acute asthma exacerbation of chronic obstructive pulmonary disease [published online October 20, 2017]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201706-485OC