A descriptive study of patients admitted with acute exacerbation of chronic obstructive pulmonary disease in three hospitals in Cape Town, South Africa

aim of this study was to determine the profiles and outcomes of patients hospitalised with acute exacerbation in the northern suburbs of the Cape metropolitan area, South Africa. Although published reports concerning the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) are available in South Africa, very little is known about the profile and admission fre- quency of patients hospitalised with acute exacerbation of COPD. This study reviewed the medical records of patients hospitalised in two state hospitals (tertiary and secondary) and one private hospital from 1 June 2004 to 1 June 2005. The information obtained retrospectively included demographics, co-morbidities, re-admission frequency, and length of stay. A total of 178 patient records were reviewed, signifi- cantly less than the 730 records identified as suitable. The mean age of patients hospitalised with acute exacerbation of COPD was 63 years (SD=12); patients were predomi- nantly males, 66% (117) were ex-smokers while 34% (61) continued to smoke during the study period. The majority (78%) of patients had at least one co-morbidity. Patients with two or more co-morbidities had an increased risk for readmission (p=0.02). In the 12 months, between 1 and 8 admissions were recorded per patient, resulting in 338 hospitalisations; 56% of the patients were hospital- ised once in the study period, 25% twice, and 19% three times. Most of the readmissions occurred at the secondary level hospital. Patients admitted to the tertiary hospital were more likely to be re-admitted: mean 2.3 admissions compared with <2 admissions at the secondary hospital. There were no significant differences in hospitalisation frequency, length of stay, and presence of co-morbid diseases for patients hospitalised at the three hospitals, which provide healthcare to a range of socio-economic groups. The study concluded that re-admission with acute exacerbation was common among a substantial proportion of COPD patients. Patients with co-morbid disease were more at risk of re-admission. Introductionexacerbation usually refers to deterioration in the patient's clinical status, with worsening of respiratory symptoms beyond the normal day-to-day variation experienced by the patient, requiring medical interven- tion. 1 These episodes may contribute significantly to the burden of lung disease. 2 At the healthcare level, there is escalation in medical resource utilisation and cost; at the individual level there is loss of income, increased physical disability, and social isolation, as well as increased risk of mortality. 3 Significantly, the presence of co-morbidities such as cardiovascular disease can influence the course of chronic obstructive pulmonary disease (COPD) and can result in more hospitalisations. 4 Research encompassing pertinent data (such as demo- graphic profile, admission frequency, and length of hospital stay) for patients hospitalised with acute exacerbation has been conducted in developed countries in an attempt to determine the impact of acute exacerbation. 5 In a retro- spective, multicentre study, Bahadori and Fitzgerald et al.