Malnutrition, Airflow Limitation and Severe Emphysema are Risks for Exacerbation of Chronic Obstructive Pulmonary Disease in Japanese Subjects: A Retrospective Single-Center Study

Mutsuo Yamaya; Osamu Usami; Shoichi Nakayama; Naoki Tode; Aya Yamada; Shunsuke Ito; Fumiya Omata; Haruki Momma; Masakatsu Funakubo; Masakazu Ichinose

doi:10.2147/COPD.S238457

Malnutrition, Airflow Limitation and Severe Emphysema are Risks for Exacerbation of Chronic Obstructive Pulmonary Disease in Japanese Subjects: A Retrospective Single-Center Study

Int J Chron Obstruct Pulmon Dis. 2020 Apr 22:15:857-868. doi: 10.2147/COPD.S238457. eCollection 2020.

Authors

Affiliations

¹ Department of Advanced Preventive Medicine for Infectious Disease, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan.
² Department of Respiratory Medicine, Kurihara Central Hospital, Kurihara 987-2205, Japan.
³ Department of Medicine, Kurihara Central Hospital, Kurihara 987-2205, Japan.
⁴ Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan.
⁵ Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan.
⁶ Department of Radiology, Kurihara Central Hospital, Kurihara 987-2205, Japan.

Abstract

Background: Different characteristics of patients with chronic obstructive pulmonary disease (COPD) between Western and Japanese populations have been reported. Risk factors for COPD exacerbation have been reported in Western countries but have not been studied in Japan.

Patients and methods: We retrospectively examined risk factors for COPD exacerbation. A total of 156 Japanese patients were enrolled, and the records of 136 patients were analyzed.

Results: In the exacerbation group (n=60), body mass index, forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), the FEV₁/FVC ratio (FEV₁/FVC), the percent predicted values of FEV₁ (%FEV₁), and serum total protein (TP) and albumin concentrations were lower, and age, mortality rate, frequency of common cold and pneumonia, COPD severity rankings, modified Medical Research Council (mMRC) dyspnea score, and proportions of patients with severe emphysema (>50% of low attenuation area) and receiving long-term oxygen therapy were higher than those in the nonexacerbation group (n=76). However, the proportion of patients with a greater number of eosinophils (≥200/μL and/or ≥2%) and the exhaled nitric oxide concentration did not differ between the two groups. In the univariate analysis, the risk factors for exacerbation were age; long-term oxygen therapy; low FVC, FEV₁, FEV₁/FVC and %FEV₁; high COPD severity ranking and mMRC score; severe emphysema; hypoproteinemia (<6.5 g/dL); hypoalbuminemia (<3.5 g/dL); leukocytosis; lymphocytopenia; and anemia. In the multivariate analysis, the risk factors were hypoalbuminemia, hypoproteinemia and low FEV₁. Additionally, in patients in the exacerbation-induced mortality subgroup, age, exacerbation frequency, mMRC score and the proportion of patients with lymphocytopenia were higher, and FVC, %FVC, FEV₁, serum TP concentration and the lymphocyte number were lower than those in the exacerbation survival subgroup.

Conclusion: Malnutrition, airflow limitation and severe emphysema were risks for exacerbation and mortality associated with infection in Japanese patients with COPD.

Keywords: airflow limitation; chronic obstructive pulmonary disease; exacerbation; malnutrition; severe emphysema.

MeSH terms

Emphysema*
Forced Expiratory Volume
Humans
Japan / epidemiology
Malnutrition* / diagnosis
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / therapy
Pulmonary Emphysema* / diagnosis
Pulmonary Emphysema* / epidemiology
Retrospective Studies
Severity of Illness Index
Vital Capacity