Validity of the diagnosis of pneumonia in hospitalised patients with COPD.
File(s)
Author(s)
Type
Journal Article
Abstract
Rationale: Exacerbations of chronic obstructive pulmonary disease (COPD) and pneumonia are two of the most common reasons for acute hospital admissions. Acute exacerbations and pneumonia present with similar symptoms in COPD patients, representing a diagnostic challenge with a significant impact on patient outcomes. The objectives of this study were to compare the prevalence of radiographic consolidation with the discharge diagnoses of hospitalised COPD patients. Methods: COPD patients admitted to three UK hospitals over a 3-year period were identified. Participants were included if they were admitted with an acute respiratory illness, COPD was confirmed by spirometry and a chest radiograph was performed within 24 h of admission. Pneumonia was defined as consolidation on chest radiograph reviewed by two independent observers. Results: There were 941 admissions in 621 patients included in the final analysis. In 235 admissions, consolidation was present on chest radiography and there were 706 admissions without consolidation. Of the 235 admissions with consolidation, only 42.9% had a discharge diagnosis of pneumonia; 90.7% of patients without consolidation had a discharge diagnosis of COPD exacerbation. The presence of consolidation was associated with increased rate of high-dependency care admission, increased mortality and prolonged length of stay. Inhaled corticosteroid use was associated with recurrent pneumonia. Conclusions: Pneumonia is underdiagnosed in patients with COPD. Radiographic consolidation is associated with worse outcomes and prolonged length of stay. Incorrect diagnosis could result in inappropriate use of inhaled corticosteroids. Future guidelines should specifically address the diagnosis and management of pneumonia in COPD.
Date Issued
2019-06-24
Date Acceptance
2019-05-14
Citation
ERJ Open Research, 2019, 5 (2), pp.1-8
ISSN
2312-0541
Publisher
European Respiratory Society
Start Page
1
End Page
8
Journal / Book Title
ERJ Open Research
Volume
5
Issue
2
Copyright Statement
©ERS 2019. This article is open access and distributed under the terms of the Creative Commons Attribution
Non-Commercial Licence 4.0.
Non-Commercial Licence 4.0.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31249841
PII: 00031-2019
Publication Status
Published online
Coverage Spatial
England
Date Publish Online
2019-06-24