Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease Clinical Outcomes

Chronic Obstructive Pulmonary Disease (COPD) is a serious medical condition and is the seventh leading cause of death¹ in Singapore. It encompasses two chronic lung diseases; bronchitis and emphysema.

Bronchitis is an inflammation of the main air passages to the lungs. It has a large amount of mucus which results in the inability to move air in and out of the lungs efficiently. On the other hand, emphysema is a condition in which the walls between the alveoli (air sacs) within the lung lose their ability to stretch and recoil. Once the elasticity is lost, air becomes trapped in the air sacs and impedes the exchange of oxygen and carbon dioxide.

The most important cause of COPD is cigarette smoking and thus, not smoking cigarettes is the best way to prevent COPD. Quitting cigarette smoking is the best and only proven way to stop the progression of this disease.

Figure 1: A Chest X-Ray of a person with COPD.

Treatment for COPD in the National University Hospital

NUH manages patients with COPD in an integrated and comprehensive program which aims at the prevention of severe attacks. Severe acute attacks of COPD are managed by the careful administration of oxygen, inhaled beta² agonists, inhaled anticholinergics, antibiotics and systemic corticosteroids. The use of Non-Invasive Ventilators (NIV) is also applied in severe cases, which helps to lower the mortality rate of the patients. NUH is one of the few hospitals which treat severe COPD with NIV in our Accident and Emergency (A&E) Department. This also ensures close cooperation between the ICU and A&E departments on the management of COPD patients.

Outcomes of COPD treatment in the National University Hospital

Due to the careful and comprehensive management of COPD patients, NUH has had a significant decrease in the length of stays (LOS), mortality and intubation rates in the ICU in the past 5 years (Figure 2). In 2005 the average length of stay for a COPD patient was 3.2 days, the mortality rate was 2.7%. A recent audit of COPD management in UK² and US³ hospitals reported an average LOS of 8.7 and 5.3 days and mortality of 7.4% and 4.4% respectively. The 3 month relapse rates of NUH have also fallen singificantly and in 2005 were 24%, which compares favourably to the 31%⁴ of the UK hospitals. Our 15 and 30 day readmission rates also compare favorably against US standards with 15 days readmission at 5.4% versus 11.1% in the US; and 30 day readmission of 14.8% versus 17.2%.

Figure 2 : Percentages of COPD patients intubated, their Average Length Of Stay (ALOS) and mortality rates in NUH from 2000 to 2005.

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Footnote:

1. Singapore Ministry of Health; Health Facts Singapore; June 2005;http://www.moh.gov.sg/corp/publications/statistics/principal.do
2. Am Fam Physician 2001;64:603-12,621-2
3. Lindenauer PK, Pekow P, Gao S, Crawford AS, Gutierrez B, Benjamin EM; Quality of Care for Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease Ann Int Med, 20th June 2006, Vol 144 Issue 12, 894-903
4. Price LC, Lowe D, Hosker H, Anstey K, Pearson M, Roberts CM.; The UK National COPD Audit 2003: impact of hospital resources and organisation of care on patient outcome following admissions for acute COPD exacerbation; Thorax. Jan 31 2006 (However, the methods use in these 2 studies were different and thus, these results should only be used as broad indicators of patient outcomes and not be compared directly).

This material does not cover all information and is not intended as a substitute for professional care. Please consult your physician on any matters regarding your health.