, Volume 41, Issue 2, pp 361–370 | Cite as

Previous outpatient antibiotic use in patients admitted to hospital for COPD exacerbations: room for improvement

  • M. Miravitlles
  • J. J. Soler-Cataluña
  • F. Baranda
  • P. Cordero
  • J.-V. Greses
  • C. de la Roza
Clinical and Epidemiological Study



Several studies have analyzed factors associated to hospitalization in chronic obstructive pulmonary disease (COPD) patients. However, data are lacking on the quality of treatment received by patients prior to hospital admission. The present study analyzed how often patients requiring hospitalization for a COPD exacerbation had received previous treatment for the exacerbation, particularly antibiotics.


This was a multicenter, cross-sectional, observational study conducted in 30 Spanish hospitals among COPD patients aged >40 years who were hospitalized for an acute exacerbation. Patients were grouped according to whether or not they had received treatment prior to admission and, subsequently, according to whether or not they had received antibiotics. Patient eligibility for antibiotic therapy was assessed using both national and European guidelines.


The study population consisted of 298 patients, of which 277 (93 %) were men, with a mean [standard deviation (SD)] age of 69.1 (9.5) years. One hundred and thirty-three patients (45 %) had received treatment prior to admission; among these, 76/133 (57 %) had received antibiotic therapy. However, 81–91 % of these patients fulfilled criteria for this therapy. Antibiotic use was significantly associated with yellow or green–yellow sputum prior to the exacerbation, a higher number of exacerbations in the previous year, more visits to emergency departments, and bronchiectasis. On the other hand, 10–20 % of patients who did receive antibiotics were not eligible for this therapy according to guidelines.


This study demonstrates a low rate of previous outpatient treatment and antibiotic use among patients with a COPD exacerbation requiring hospital admission.


COPD Antibiotics Hospitalization Exacerbation 


  1. 1.
    Miravitlles M, Ferrer M, Pont A, Zalacain R, Alvarez-Sala JL, Masa F, et al. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax. 2004;59:387–95.PubMedCrossRefGoogle Scholar
  2. 2.
    Miravitlles M, Mayordomo C, Artés M, Sánchez-Agudo L, Nicolau F, Segú JL. Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. EOLO Group. Estudio Observacional de la Limitación Obstructiva al Flujo aEreo. Respir Med. 1999;93:173–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Connors AF Jr, Dawson NV, Thomas C, Harrell FE Jr, Desbiens N, Fulkerson WJ, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med. 1996;154:959–67.PubMedCrossRefGoogle Scholar
  4. 4.
    Burrows B, Earle RH. Course and prognosis of chronic obstructive lung disease. A prospective study of 200 patients. N Engl J Med. 1969;280:397–404.PubMedCrossRefGoogle Scholar
  5. 5.
    Soler J, Sánchez L, Latorre M, Alamar J, Román P, Perpiñá M. The impact of COPD on hospital resources: the specific burden of COPD patients with high rates of hospitalization. Arch Bronconeumol. 2001;37:375–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Garcia-Aymerich J, Serra Pons I, Mannino DM, Maas AK, Miller DP, Davis KJ. Lung function impairment, COPD hospitalisations and subsequent mortality. Thorax. 2011;66:585–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Matkovic Z, Huerta A, Soler N, Domingo R, Gabarrús A, Torres A, et al. Predictors of adverse outcome in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. Respiration. 2012;84:17–26.PubMedCrossRefGoogle Scholar
  8. 8.
    Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925–31.PubMedCrossRefGoogle Scholar
  9. 9.
    Miravitlles M, Murio C, Guerrero T, Gisbert R; On behalf of the DAFNE Study Group. Costs of chronic bronchitis and COPD: a 1-year follow-up study. Chest. 2003;123:784–91.PubMedCrossRefGoogle Scholar
  10. 10.
    Miravitlles M, Murio C, Guerrero T, Gisbert R; DAFNE Study Group. Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest. 2002;121:1449–55.PubMedCrossRefGoogle Scholar
  11. 11.
    Garcia-Aymerich J, Barreiro E, Farrero E, Marrades RM, Morera J, Antó JM. Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study). Eur Respir J. 2000;16:1037–42.PubMedCrossRefGoogle Scholar
  12. 12.
    Wilkinson TM, Donaldson GC, Hurst JR, Seemungal TA, Wedzicha JA. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169:1298–303.PubMedCrossRefGoogle Scholar
  13. 13.
    Miravitlles M. Epidemiology of chronic obstructive pulmonary disease exacerbations. Clin Pulm Med. 2002;9:191–7.CrossRefGoogle Scholar
  14. 14.
    Wilson R. Bacteria, antibiotics and COPD. Eur Respir J. 2001;17:995–1007.PubMedCrossRefGoogle Scholar
  15. 15.
    Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GKM, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106:196–204.PubMedCrossRefGoogle Scholar
  16. 16.
    Balter MS, La Forge J, Low DE, Mandell L, Grossman RF; The Chronic Bronchitis Working Group. Canadian guidelines for the management of acute exacerbations of chronic bronchitis. Can Respir J. 2003;10(Suppl B):3B–32B.PubMedGoogle Scholar
  17. 17.
    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 Intern Med. 2006;144:894–903.PubMedCrossRefGoogle Scholar
  18. 18.
    Incalzi RA, Corsonello A, Pedone C, Masotti G, Rengo F, Grassi V, et al. Use of antibiotics in elderly patients with exacerbated COPD: the OLD-Chronic Obstructive Pulmonary Disease Study. J Am Geriatr Soc. 2006;54:642–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Miravitlles M, Monsó E, Mensa J, Aguarón Pérez J, Barberán J, Bárcena Caamaño M, et al. Tratamiento antimicrobiano de la agudización de la EPOC: Documento de Consenso 2007. Arch Bronconeumol. 2008;44:100–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections—summary. Clin Microbiol Infect. 2011;17(Suppl 6):1–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Langsetmo L, Platt RW, Ernst P, Bourbeau J. Underreporting exacerbation of chronic obstructive pulmonary disease in a longitudinal cohort. Am J Resp Crit Care Med. 2008;177:396–401.PubMedCrossRefGoogle Scholar
  22. 22.
    Miravitlles M, Brosa M, Velasco M, Crespo C, Gobartt E, Diaz S, et al. An economic analysis of pharmacological treatment of COPD in Spain. Respir Med. 2009;103:714–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Sánchez López J, Bueno Cavanillas A. Factores asociados al uso inadecuado de un servicio de urgencias hospitalario. Emergencias. 2005;17:138–44.Google Scholar
  24. 24.
    Garcia-Aymerich J, Escarrabill J, Marrades RM, Monsó E, Barreiro E, Antó JM; EFRAM Investigators. Differences in COPD care among doctors who control the disease: general practitioner vs. pneumologist. Respir Med. 2006;100:332–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Murio C, Soler X, Pérez M, Calero G, Ruiz-Manzano J. Acute exacerbation of chronic obstructive pulmonary disease in primary care setting in Spain: the EPOCAP study. Ther Adv Respir Dis. 2010;4:215–23.PubMedCrossRefGoogle Scholar
  26. 26.
    Aaron SD, Donaldson GC, Whitmore GA, Hurst JR, Ramsay T, Wedzicha JA. Time course and pattern of COPD exacerbation onset. Thorax. 2012;67:238–43.PubMedCrossRefGoogle Scholar
  27. 27.
    Miravitlles M. Is it possible to reduce the use of antibiotics in severe exacerbations of chronic obstructive pulmonary disease? Respiration. 2008;76:249–50.PubMedGoogle Scholar
  28. 28.
    Adams SG, Melo J, Luther M, Anzueto A. Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD. Chest. 2000;117:1345–52.PubMedCrossRefGoogle Scholar
  29. 29.
    Miravitlles M, Murio C, Guerrero T; On behalf of the DAFNE Study Group. Factors associated with relapse after ambulatory treatment of acute exacerbations of chronic bronchitis. A prospective multicenter study in the community. Eur Respir J. 2001;17:928–33.PubMedCrossRefGoogle Scholar
  30. 30.
    Beauchesne MF, Julien M, Julien LA, Piquette D, Forget A, Labrecque M, et al. Antibiotics used in the ambulatory management of acute COPD exacerbations. Int J Chron Obstruct Pulmon Dis. 2008;3:319–22.PubMedGoogle Scholar
  31. 31.
    Miravitlles M, Marín A, Monsó E, Vilà S, de la Roza C, Hervás R, et al. Colour of sputum is a marker for bacterial colonisation in chronic obstructive pulmonary disease. Respir Res. 2010;11:58.PubMedCrossRefGoogle Scholar
  32. 32.
    Martínez-García MÁ, Soler-Cataluña JJ, Donat Sanz Y, Catalán Serra P, Agramunt Lerma M, Ballestín Vicente J, et al. Factors associated with bronchiectasis in patients with COPD. Chest. 2011;140:1130–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA, et al. Spanish COPD guidelines (GesEPOC): pharmacological treatment of stable COPD. Arch Bronconeumol. 2012;48:247–57.PubMedCrossRefGoogle Scholar
  34. 34.
    Miravitlles M, Marín A, Monsó E, Vilà S, de la Roza C, Hervás R, et al. Efficacy of moxifloxacin in the treatment of bronchial colonisation in COPD. Eur Respir J. 2009;34:1066–71.PubMedCrossRefGoogle Scholar
  35. 35.
    Sethi S, Jones PW, Theron MS, Miravitlles M, Rubinstein E, Wedzicha JA, et al. Pulsed moxifloxacin for the prevention of exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Respir Res. 2010;11:10.PubMedCrossRefGoogle Scholar
  36. 36.
    Albert RK, Connett J, Bailey WC, Casaburi R, Cooper JAD Jr, Criner GJ, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365:689–98.PubMedCrossRefGoogle Scholar
  37. 37.
    Pomares X, Montón C, Espasa M, Casabon J, Monsó E, Gallego M. Long-term azithromycin therapy in patients with severe COPD and repeated exacerbations. Int J Chron Obstruct Pulmon Dis. 2011;6:449–56.PubMedCrossRefGoogle Scholar
  38. 38.
    Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Arch Bronconeumol. 2012;48:86–98.PubMedCrossRefGoogle Scholar
  39. 39.
    Miravitlles M, Kruesmann F, Haverstock D, Perroncel R, Choudhri SH, Arvis P. Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis. Eur Respir J. 2012;39:1354–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Ruef C. Antibiotic resistance really starts to hurt. Infection. 2011;39:499–500.PubMedCrossRefGoogle Scholar
  41. 41.
    Chalupa P, Beran O, Herwald H, Kaspříková N, Holub M. Evaluation of potential biomarkers for the discrimination of bacterial and viral infections. Infection. 2011;39:411–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupré A, Bégin R, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003;163:585–91.PubMedCrossRefGoogle Scholar
  43. 43.
    Gadoury M-A, Schwartzman K, Rouleau M, Maltais F, Julien M, Beaupré A, et al. Self-management reduces both short- and long-term hospitalisation in COPD. Eur Resp J. 2005;26:853–7.CrossRefGoogle Scholar
  44. 44.
    Stenton C. The MRC breathlessness scale. Occup Med (Lond). 2008;58:226–7.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • M. Miravitlles
    • 1
    • 6
  • J. J. Soler-Cataluña
    • 2
  • F. Baranda
    • 3
  • P. Cordero
    • 4
  • J.-V. Greses
    • 4
  • C. de la Roza
    • 5
  1. 1.Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Ciber de Enfermedades Respiratorias (CIBERES)Hospital ClinicBarcelonaSpain
  2. 2.Pneumology Unit, Internal Medicine ServiceHospital de RequenaValenciaSpain
  3. 3.Department of PneumologyHospital Universitario CrucesBilbaoSpain
  4. 4.Department of PneumologyHospital Nisa 9 de OctubreValenciaSpain
  5. 5.Medical DepartmentBayer HispaniaSant Joan DespíSpain
  6. 6.Servei de PneumologiaHospital ClinicBarcelonaSpain

Personalised recommendations