Consultant at the department Therapeutic and Education Clinic of University Baku, Azerbaijan
Introduction: The impact of coexistent ILAs on the manifestations and outcomes of COPD and emphysema is not fully described.The aim of current study was to evaluate the impact of presence and progression of ILAs to the outcomes ,particularly ICU admission rate of patients with COPD.
Methods: A retrospective study was conducted between January 2018 and December 2023 of patients with COPD who were admitted to the pulmonary and critical care department of university teaching hospital and who underwent chest CT imaging and longitidunal pulmonary function tests.
Results: Of 583 patients with COPD exacerbations ,68 and 209 patients had equivocal and definitive ILAs,respectively.Patients with ILAs were significantly older and had lower FEV1 and FVC than patients without ILAs(p < 0.002).DLCO was lower (p < 0.001).Pulmonary artery hypertension was higher (OR 1.84[0.68-3.22];p < 0.003) and COPD exacerbations rate leading to hospitalisation of patients was higher (OR 2.41[091-4.31];p < 0.001).Rehospitalisation rate also was higher compared to patients without ILAs(2.55[0.79-5.12];p < 0.001). In patients with COPD associated with ILAs hypoxemia and hypercapnia were common findings compared to COPD patients without ILAs(2.16[0.69-4.52];p < 0.002 and 1.92[0.71-3.82];p < 0.004).During longitudinal 5.11 years fllow-up period the severity of persistent hypoxemia was increased with decreased of FVC which were indicated to the progression of the ILAs.ICU admission rate was higher in patients with ILAs associated COPD (3.44[1.12-6.22];p < 0.001) and common risk factor associated with ICU admission was the failure of NIV(p < 0.01).Intubation rate also was higher in patients with COPD plus ILAs(1.84[0.68-3.16];p < 0.02).Mortality was hgiher in these patients (p < 0.002) and independent risk factors associated with hgiher mortality rate were extent ILAs and low FVC(p < 0.001)
Conclusions: COPD associated with ILAs are characterized with more frequent exacerbations ,hospitalizations and rehospitalizations rates.ICU admission rate was higher suggested more severe disease course related to progression of ILAs and more severe COPD clinical features. In patients with COPD and ILAs NIV failure leading to intubation was common and mortality rate also was higher regarding the presence of extent ILAs changes and progressive decline of FVC.
