Journal of General Internal Medicine

, Volume 22, Issue 6, pp 799–804 | Cite as

Factors Associated with Frequency of Emergency Department Visits for Chronic Obstructive Pulmonary Disease Exacerbation

  • Chu-Lin Tsai
  • Sharon K. Griswold
  • Sunday Clark
  • Carlos A. CamargoJr.
Original Article



Little is known about the factors associated with frequency of emergency department visits (FEDV) in chronic obstructive pulmonary disease (COPD) patients with recurrent exacerbations.


To characterize the use of emergency department (ED) services in patients with COPD exacerbation and identify factors associated with FEDV.


A prospective, multicenter cohort study.


Three hundred eighty-eight patients were included. Fifty-two percent were women and the median age was 69 years (interquartile range 62–76).


Using a standard questionnaire, consecutive ED patients with COPD exacerbation were interviewed. The number of ED visits in the previous year was retrospectively collected.


Over the past year, this cohort reported a total of 1,090 ED visits because of COPD exacerbation. Thirteen percent of COPD patients had 6 or more ED visits, accounting for 57% of the total ED visits in the past year. Multivariate analysis showed that patients with an increased FEDV were more likely to be Hispanic (incidence rate ratio [IRR] 1.97, 95% confidence interval [CI] 1.16–3.33), to have more severe COPD as determined by previous hospitalizations (IRR 2.06, 95% CI 1.51–2.82), prior intubations (IRR 1.49, 95% CI 1.02–2.18), prior use of systemic corticosteroids (IRR 1.57, 95% CI 1.16–2.13) and methylxanthine (IRR 1.48, 95% CI 1.04–2.12), and less likely to have a primary care provider (IRR 0.51, 95% CI 0.31–0.82).


Our results suggest that both disease and health care-related factors were associated with FEDV in COPD exacerbation. Multidisciplinary efforts through primary care provider follow-up should be assessed to test the effects on reducing the high morbidity and cost of recurrent COPD exacerbations.


chronic obstructive pulmonary disease emergency department visits primary care provider recurrent exacerbation 



Chronic obstructive pulmonary disease


Emergency department



The authors thank the EMNet investigators for their ongoing dedication to public health research, with an emphasis on the treatment and prevention of respiratory/allergy emergencies. The cohort studies were supported by an unrestricted grant from Boehringer Ingelheim (Ridgefield, Conn, USA and Burlington, Ontario, Canada).

EMNet Steering Committee: Michelle P. Blanda, MD; Edwin D. Boudreaux, PhD; Carlos A. Camargo, Jr., MD (Chair); Rita K. Cydulka, MD; Theodore J. Gaeta, DO, MPH; Susan Key, RN, MS, CEN; Steven Polevoi, MD; Michael S. Radeos, MD, MPH; and Benjamin C. Sun, MD, MPP.

EMNet Coordinating Center: Christina Ahn; Carlos A. Camargo, Jr., MD (Director); Sunday Clark, MPH, ScD; Lisa A. Dubois; Kate E. Delaney; Adit A. Ginde, MD; Andrea J. Pelletier, MS, MPH; Ashley F. Sullivan, MS, MPH; Chu-Lin Tsai, MD, MPH (all from the Massachusetts General Hospital, Boston, Mass, USA).

Principal Investigators at the 29 Participating Sites: FC Baker III (Maine Medical Center, Portland, Maine, USA); MP Blanda (Summa Health System, Akron, Ohio, USA); ED Boudreaux (Earl K. Long Memorial Hospital, Baton Rouge, La, USA); BE Brenner (The Brooklyn Hospital Center, Brooklyn, NY, USA); CA Camargo, Jr. (Massachusetts General Hospital, Boston, Mass, USA); RK Cydulka (MetroHealth Medical Center, Cleveland, Ohio, USA); TJ Gaeta (New York Methodist Hospital, Brooklyn, NY, USA); B Goldfeder (Shands Hospital at the Univeristy of Florida, Gainesville, Fla, USA); RJ Grant (Hartford Hospital, Hartford, Conn, USA); RO Gray (Hennepin County Medical Center, Minneapolis, Minn, USA); A Guttman (Sir Mortimer B. Davis, Jewish General Hospital, Montreal, Quebec, Canada); LW Kreplick (Christ Hospital and Medical Center, Oak Lawn, Ill, USA); DS Mackey (Lethbridge Regional Hospital, Lethbridge, Alberta, Canada); A Mangione (Albert Einstein Medical Center, Philadelphia, Pa, USA); J Peters (University of Texas Health Sciences Center at San Antonio, San Antonio, Tex, USA); MS Radeos (Lincoln Medical Center, Bronx, NY); PL Rice (Brigham and Women’s Hospital, Boston, Mass, USA); BH Rowe (University of Alberta Hospital, Edmonton, Alberta, Canada); M Sama (St. Joseph Mercy Hospital, Ann Arbor, Mich, USA); D Schreiber (Stanford University Medical Center, Stanford, Calif, USA); NI Shapiro (Beth Israel Deaconess Medical Center, Boston, Mass, USA); PC Shukla (University of Texas Southwestern Medical Center, Dallas, Tex, USA); D Sinclair (Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada); H Smithline (Baystate Medical Center, Springfield, Mass, USA); PE Sokolove (UC Davis Medical Center, Sacramento, Calif, USA); M Steffens (Palmetto Richland Memorial Hospital, Columbia, SC, USA); CA Terregino (Cooper Hospital/University Medical Center, Camden, NJ, USA); A Travers (Royal Alexandria Hospital, Edmonton, Alberta, Canada); and EJ Weber (UCSF Medical Center, San Francisco, Calif, USA).

Conflict of interest statement

Dr. Camargo has received financial support (research grants, consulting, lectures) from AstraZeneca (Wilmington, Del, USA), Boehringer Ingelheim (Ridgefield, Conn, USA), GlaxoSmithKline (Research Triangle Park, NC, USA), Novartis (East Hanover, NJ, USA), and Schering Plough (Kenilworth, NJ, USA). All other authors declare that they have no conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Chu-Lin Tsai
    • 1
    • 2
    • 4
  • Sharon K. Griswold
    • 3
  • Sunday Clark
    • 2
  • Carlos A. CamargoJr.
    • 1
    • 2
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of Emergency MedicineThomas Jefferson University HospitalPhiladelphiaUSA
  4. 4.Department of Emergency MedicineMassachusetts General HospitalBostonUSA

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