Validity of the diagnosis of pneumonia in hospitalised patients with COPD
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 p...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2019-06-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/5/2/00031-2019.full |
| _version_ | 1818260518889062400 |
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| author | Lydia J. Finney Vijay Padmanaban Samuel Todd Nadia Ahmed Sarah L. Elkin Patrick Mallia |
| author_facet | Lydia J. Finney Vijay Padmanaban Samuel Todd Nadia Ahmed Sarah L. Elkin Patrick Mallia |
| author_sort | Lydia J. Finney |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-12T18:32:37Z |
| format | Article |
| id | doaj.art-136e6f07919c42369429fb1414d7f03c |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-12-12T18:32:37Z |
| publishDate | 2019-06-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-136e6f07919c42369429fb1414d7f03c2022-12-22T00:15:52ZengEuropean Respiratory SocietyERJ Open Research2312-05412019-06-015210.1183/23120541.00031-201900031-2019Validity of the diagnosis of pneumonia in hospitalised patients with COPDLydia J. Finney0Vijay Padmanaban1Samuel Todd2Nadia Ahmed3Sarah L. Elkin4Patrick Mallia5 National Heart and Lung Institute, Imperial College, London, UK Imperial College Healthcare NHS Trust, London, UK Imperial College Healthcare NHS Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK Imperial College Healthcare NHS Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK 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.http://openres.ersjournals.com/content/5/2/00031-2019.full |
| spellingShingle | Lydia J. Finney Vijay Padmanaban Samuel Todd Nadia Ahmed Sarah L. Elkin Patrick Mallia Validity of the diagnosis of pneumonia in hospitalised patients with COPD ERJ Open Research |
| title | Validity of the diagnosis of pneumonia in hospitalised patients with COPD |
| title_full | Validity of the diagnosis of pneumonia in hospitalised patients with COPD |
| title_fullStr | Validity of the diagnosis of pneumonia in hospitalised patients with COPD |
| title_full_unstemmed | Validity of the diagnosis of pneumonia in hospitalised patients with COPD |
| title_short | Validity of the diagnosis of pneumonia in hospitalised patients with COPD |
| title_sort | validity of the diagnosis of pneumonia in hospitalised patients with copd |
| url | http://openres.ersjournals.com/content/5/2/00031-2019.full |
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