Kang et al identified factors associated with the severity of an exacerbation of chronic obstructive pulmonary disease (COPD) requiring hospital admission. These can help to identify a patient who may require more aggressive management. The authors are from The Catholic University of Korea.
Patient selection: acute exacerbation of COPD requiring hospital admission
Exclusion: pneumonia, lung cancer, treatment of other medical conditions, chronic steroid therapy
Parameters:
(1) congestive heart failure
(2) eosinophilic phenotype on admission (> 2% eosinophils in the peripheral blood count)
(3) neutrophilic phenotype on admission (> 65% neutrophils in peripheral blood count OR leukocyte count > 11,000 per µL, with leukocyte count interpreted as the white blood cell count rather than absolute neutrophil count)
If the patient met the criteria for both eosinophilic and neutrophilic phenotypes then the patient was be classified as an eosinophilic exacerbation (page 2469).
Risk factors for ICU admission:
(1) congestive heart failure (odds ratio 3.4)
(2) neutrophilic phenotype (odds ratio 2.8)
The eosiniophilic phenotype was associated with better pulmonary function test results.
