Ondrej Sobotik

Czech multicenter research database of severe COPD

Purpose Chronic obstructive pulmonary disease (COPD) has been recognized as a heterogeneous, multiple organ system-affecting disorder. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) places emphasis on symptom and exacerbation management. The aim of this study is examine the course of COPD and its impact on morbidity and all-cause mortality of patients, with respect to individual phenotypes and GOLD categories. This study will also evaluate COPD real-life patient care in the Czech Republic. Patients and methods The Czech Multicentre Research Database of COPD is projected to last for 5 years, with the aim of enrolling 1,000 patients. This is a multicenter, observational, and prospective study of patients with severe COPD (post-bronchodilator forced expiratory volume in 1 second ≤60%). Every consecutive patient, who fulfils the inclusion criteria, is asked to participate in the study. Patient recruitment is done on the basis of signed informed consent. The study was approved by the Multicentre Ethical Committee in Brno, Czech Republic. Results The objective of this paper was to outline the methodology of this study. Conclusion The establishment of the database is a useful step in improving care for COPD subjects. Additionally, it will serve as a source of data elucidating the natural course of COPD, comorbidities, and overall impact on the patients. Moreover, it will provide information on the diverse course of the COPD syndrome in the Czech Republic.

Acute exacerbations of COPD: The influence of comorbidities and chronic medication on mortality and exacerbation rate

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the developed world and represents an important public health challange. The COPD burden is considered to increase in the future because of ageing population and continued exposure to COPD risk factors. We have consecutively collected data from patients with mild or severe exacerbation, requiring admission either to intensive care unit (ICU) or to our main ward. During the year 2014, there were 226 COPD exacerbations requiring admission to hospital, 31 exacerbations were treated in ICU and 195 in our main ward. A prospective study in a well caracterised cohort of our patients was performed. We have assessed whether presence of comorbidities (diabetes, ischemic heart disease, arterial hypertension, atrial fibrillation, asthma, cancer, peptic ulcer disease, osteoporosis and depression), severity of airway obstruction or specific COPD fenotype were related to exacerbation frequency and resulting mortality of our patients. We have found that patients with frequent exacerbations (≥ 2 per year) had significantly more often asthma (22.7%) and atopic syndrome (25%) compared to patients with single exacerbation per year (7.3% and 10.1%, p=0.00174 and p=0.0075) On the other hand, there was no significantly increased prevalence of depression or ischemic heart disease in patients with frequent exacercerbations. Futhermore we haven´t found that using inhaled corticoseroids had an influence on the exacerbation rate of our patients. Existence of atopy, asthma bronchiale and astma/COPD overlap syndrome increase the frequency of exacerbations in COPD patients.