Chronic obstructive pulmonary disease at Chulalongkorn Hospital: an analysis of 400 episodes
Limthongkul, S.; Wongthim, S.; Udompanich, V.; Charoenlap, P.; Nuchprayoon, C.
Journal of the Medical Association of Thailand 74(12): 639-646
1991
ISSN/ISBN: 0125-2208 PMID: 1813589 Document Number: 376850
Four hundred episodes of COPD among patients admitted to Chulalongkorn Hospital [Bangkok, Thailand] between 1982 and 1986 were analyzed. There were 193 males and 45 females with 325 and 75 episodes of admission, respectively; the average age on admission was 68.4 .+-. 0.5 years. The most significant associated underlying factor was cigarette smoking in 94 per cent of the cases, with the patients smoking an average of 1.15 packs of cigarettes per day for 43 years. In our study, 26.8 per cent of the patients had a cough, with the average age at onset being 47.4 .+-. 2.1 years. The most common clinical manifestation was dyspnea with 58.5, 35.2 and 0.5 per cent having dyspnea functional class II, III, IV and with the average age at onset being 61.1 .+-. 0.7, 66.6 .+-. 0.7 and 71.0 .+-. 1.0 years, respectively. An important manifestation on administration was dyspnea functional class III and IV, which were present in of 89 per cent of the cases. The main precipitating factors which led to the patients' admission were upper respiratory tract infection, pneumonia, bronchospasms and congestive heart failure, which accounted for 48.0, 10.0, 8.5, 31.8 and 18.3 per cent of the cases, respectively. With regard to these complications, there were 16.5, 48.3, 31.1 and 12.5 per cent of the patients who suffered respiratory failure requiring assisted ventilation, corpulmonale, polycythemia and peptic ulcer, respectively. Arterial blood gas on admission revealed a pH level of 7.36 .+-. 0.1, pCO2 of 53.3 .+-. 23.7 torr, and PO2 of 54.2 .+-. 19.9 torr. The average FEV1 and FVC were 0.58 .+-. 0.39 and 1.27 .+-. 0.69 liters, respectively. Chest roentgenography showed that half (50.8%) of the patients had hyperinflation of the lung. The average duration of hospitalization was 17.5 days. The overall mortality rate was 16.3 per cent. High risk factors for the non-survival group were being over 72 years of age, having the onset of dyspnea functional class II being at more than 64.5 years of age, on admission having an arterial pH level of less than 7.30, having medical complications of respiratory failure requiring assisted ventilation or pneumonia, pneumothorax and congestive heart failure.