Risk factors associated to COPD worsening in Italian general practices: The 12 month COMODHES follow-up study

Background: reduction of risk factor exposure in Chronic Obstructive Pulmonary Disease (COPD) patients can reduce the disease worsening. Aim: to evaluate the risk factors associated with 12 month worsening of COPD in patients of Italian general practitioners (GPs). Methods: prospective observational study in different Italian areas. 139 GPs enrolled 1874 patients with COPD diagnosis. Questionnaires were used to collect data on COPD management, health status and risk factors at baseline and after 12 months. COPD worsening was defined as a 1+ level shift in the severity categories. Univariate analyses were run to assess the relationship between gender, age, risk factor exposure, GPs' disease management and 12 month COPD worsening. Multiple logistic regression analysis was run to evaluate the risk factors associated with COPD worsening, adjusting for potential confounders. Results: 784 patients had complete information to assess the variations in COPD severity according to the 2011 GOLD guidelines. After 12 months, 15.6% of patients had a worsening of the severity level. Univariate analyses showed a significantly higher frequency of worsening in smokers, as well as in patients without a specialist/GP supervision, not using pneumococcal/influenza vaccinations and without an appropriate drug prescription. The logistic regression analysis highlighted significant associations between severity worsening and older age (>74 yrs) (OR 1.92), active smoke (OR 2.10) and unappropriate COPD treatment (OR 3.26). Conclusions: in order to try to stop COPD worsening it is important to help patients quitting smoking and to prescribe appropriate medicines.