Malnutrition, Airflow Limitation and Severe Emphysema are Risks for Exacerbation of Chronic Obstructive Pulmonary Disease in Japanese Subjects: A Retrospective Single-Center Study

• Published in: International journal of chronic obstructive pulmonary disease Vol. 15; pp. 857 - 868
• Main Authors: Yamaya, Mutsuo, Usami, Osamu, Nakayama, Shoichi, Tode, Naoki, Yamada, Aya, Ito, Shunsuke, Omata, Fumiya, Momma, Haruki, Funakubo, Masakatsu, Ichinose, Masakazu
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2020; Dove Medical Press Ltd; Dove; Dove Medical Press
• Subjects: airflow limitation; Albumin; Anemia; Biomarkers; Body mass index; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Colds; Common cold; Diseases; Dyspnea; Emphysema; Ethics; exacerbation; Infections; Japan; Lung diseases; Lung volume measurement; Lymphocytes; Lymphocytopenia; Malnutrition; Medical research; Mortality; Nitric oxide; Nitrogen oxides; Original Research; Oxygen therapy; Patients; Pneumonia; Proteins; Respiratory tract diseases; Risk factors; severe emphysema; Steroids; Japan; airflow limitation; malnutrition; severe emphysema; chronic obstructive pulmonary disease; exacerbation
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S238457

Different characteristics of patients with chronic obstructive pulmonary disease (COPD) between Western and Japanese populations have been reported. Risk factors for COPD exacerbation have been reported in Western countries but have not been studied in Japan. We retrospectively examined risk factors for COPD exacerbation. A total of 156 Japanese patients were enrolled, and the records of 136 patients were analyzed. In the exacerbation group (n=60), body mass index, forced vital capacity (FVC), forced expiratory volume in one second (FEV ), the FEV /FVC ratio (FEV /FVC), the percent predicted values of FEV (%FEV ), and serum total protein (TP) and albumin concentrations were lower, and age, mortality rate, frequency of common cold and pneumonia, COPD severity rankings, modified Medical Research Council (mMRC) dyspnea score, and proportions of patients with severe emphysema (>50% of low attenuation area) and receiving long-term oxygen therapy were higher than those in the nonexacerbation group (n=76). However, the proportion of patients with a greater number of eosinophils (≥200/μL and/or ≥2%) and the exhaled nitric oxide concentration did not differ between the two groups. In the univariate analysis, the risk factors for exacerbation were age; long-term oxygen therapy; low FVC, FEV , FEV /FVC and %FEV ; high COPD severity ranking and mMRC score; severe emphysema; hypoproteinemia (<6.5 g/dL); hypoalbuminemia (<3.5 g/dL); leukocytosis; lymphocytopenia; and anemia. In the multivariate analysis, the risk factors were hypoalbuminemia, hypoproteinemia and low FEV . Additionally, in patients in the exacerbation-induced mortality subgroup, age, exacerbation frequency, mMRC score and the proportion of patients with lymphocytopenia were higher, and FVC, %FVC, FEV , serum TP concentration and the lymphocyte number were lower than those in the exacerbation survival subgroup. Malnutrition, airflow limitation and severe emphysema were risks for exacerbation and mortality associated with infection in Japanese patients with COPD.