Reversible hypercapnia in acute exacerbations of chronic obstructive pulmonary disease (COPD).

We prospectively studied emergency hospitalizations due to acute exacerbations of chronic obstructive pulmonary disease (COPD) among 74 hypercapnic patients, in order to determine factors which predict reversal to normocapnia as a result of therapy. Clinical, arterial blood gas and pulmonary function data on presentation were compared to predischarge values among those 58 patients who survived the admission. Patients were divided into those who reverted to normocapnia (reversible, 40% of surviving patients), and those who remained hypercapnic (chronic, 60% of surviving patients). Reversible patients had higher admission arterial oxygen tension (PaO2) levels than those with chronic hypercapnia (6.4 +/- 1.3 kPa (mean +/- SD), as compared to 5.7 +/- 1.1 kPa) better pulmonary function (forced expiratory volume in one second (FEV1) 35 +/- 16% predicted, as compared to 26 +/- 7.9), and a lower prevalence of cor pulmonale (30% as compared to 63% of patients). No admission variable(s) distinguished individual patients as reversible or chronic hypercapnic, and, in particular, admission arterial carbon dioxide tension (PaCO2) and pH levels were similar in both groups. Furthermore, there were no differences between survivors and those 16 patients who died during the admission, apart from a higher urea level among those who died. These findings suggest that reversible patients have milder underlying disease than those with chronic hypercapnia. Our data establish the high prevalence of reversible hypercapnia among patients hospitalized with exacerbations of COPD, and, furthermore, indicate that patients who are normocapnic in the stable state can develop similar levels of hypercapnia during exacerbations as those with chronic hypercapnia.

• Publication year

  1993

• Venue

  European Respiratory Journal

• Publication date

  1993-10-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1183/09031936.93.06091353PMID 8287954
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Survival of acute respiratory failure.

  2020cited by this paper
• Hyperoxic-induced hypercapnia in stable chronic obstructive pulmonary disease.

  2015cited by this paper
• Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management.

  1992cited by this paper
• Acute or chronic respiratory failure. Assessment and management of patients with COPD in the emergency setting.

  1989cited by this paper
• When should patients with COPD be ventilated?

  1987cited by this paper
• Predictors of survival in subjects with chronic airflow limitation.

  1983cited by this paper
• Respiratory failure revisited: acute exacerbations of chronic bronchitis between 1961-68 and 1970-76.

  1980cited by this paper
• The management of acute ventilatory failure in chronic obstructive lung disease.

  1973cited by this paper
• Conservative and respirator treatment of acute respiratory insufficiency in patients with chronic obstructive lung disease. A reappraisal.

  1972cited by this paper
• Survival of acute respiratory failure. A study of 239 episodes.

  1969cited by this paper
• Prognosis of patients with chronic obstructive pulmonary disease after hospitalization for acute ventilatory failure: a three-year follow-up study.

  1966cited by this paper

• Phenotypes, Etiotypes, and Endotypes of Exacerbations of Chronic Obstructive Pulmonary Disease.

  2023cites this paper
• Oxygen-induced hypercapnia: physiological mechanisms and clinical implications.

  2022cites this paper
• Reversibility of Hypercapnia after an Acute Exacerbation of COPD

  2022cites this paper
• Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease.

  2020influential citation
• Frequency and predictors of obesity hypoventilation in hospitalized patients at a tertiary health care institution

  2014cites this paper
• The Story of Oxygen

  2013cites this paper
• Admission prevention in COPD: non-pharmacological management

  2013cites this paper
• Predictors of in-hospital mortality and need for invasive mechanical ventilation in elderly COPD patients presenting with acute hypercapnic respiratory failure

  2013cites this paper
• Long‐term non‐invasive ventilation to manage persistent ventilatory failure after COPD exacerbation

  2010cites this paper
• Time course and recovery of arterial blood gases during exacerbations in adults with Cystic Fibrosis.

  2009cites this paper
• Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease.

  2006cites this paper
• Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure.

  2006cites this paper
• Effects of acute on chronic respiratory failure on hypercapnia and 3-month survival.

  2006cites this paper
• Lung and respiratory muscle function at discharge from a respiratory intensive care unit.

  2005cites this paper
• Effects of Acute on Chronic Respiratory Failure on Hypercapnia and 3-Month Survival

  2005cites this paper
• Long-Term Oxygen Therapy Stops the Natural Decline of Endurance in COPD Patients with Reversible Hypercapnia

  2004cites this paper
• Kronik Obstrüktif Akciğer Hastaliğinin Akut Atağinda Reversibl Hiperkapni

  2002cites this paper
• Emphysema in nonsmokers: alpha 1-antitrypsin deficiency and other causes.

  2002cites this paper
• Oxygen therapy for hypercapnic patients with chronic obstructive pulmonary disease and acute respiratory failure: A randomized, controlled pilot study

  2002cites this paper
• Audit of acute admissions of COPD: standards of care and management in the hospital setting.

  2001cites this paper
• Respiratory disease in old age: Research into Ageing Workshop, London, 1998

  2000cites this paper
• Reversible hypercapnia in chronic obstructive pulmonary disease: a distinct pattern of respiratory failure with a favorable prognosis.

  1997cites this paper
• The changing role of mechanical ventilation in COPD.

  1996cites this paper
• Effect o of p protriptyline, 1 10 m mg d daily, o on c chronic h hypoxaemia iin chronic o obstructive p pulmonary d disease

  1995cites this paper
• Effect of protriptyline, 10 mg daily, on chronic hypoxaemia in chronic obstructive pulmonary disease.

  1995cites this paper
• La ventilation non invasive dans le traitement des insuffisances respiratoires chroniques décompensées

  1995cites this paper