Study of Epidemiological & Clinical Profile of Chronic Obstructive Pulmonary Disease Patient at a Tertiary Care Hospital in Eastern Rajasthan.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterised by chronic respiratory symptoms due to abnormalities of the airways and/or alveoli, causing persistent, often progressive, airflow obstruction.1 It is the third leading cause of death globally, responsible for approximately 3.23 million deaths annually.2,3 India bears a disproportionate burden, with an estimated prevalence of 4.2–9.1% among adults above 30 years and the highest number of COPD deaths worldwide.4,5. Acute exacerbation of COPD (AECOPD) is defined as an event characterised by increased dyspnoea and/or cough and sputum that worsens in ≤14 days, often associated with increased local and systemic inflammation caused by infection, pollution, or other airway insults.1,6 AECOPD episodes accelerate lung function decline, impair quality of life, increase hospitalisation, and contribute significantly to mortality.7,8 Previous hospitalisation for AECOPD is an independent predictor of readmission (OR 3.1), with 6-month readmission rates exceeding 50%.9

 

The clinical profile of AECOPD is shaped by multiple factors including disease severity, comorbidities, precipitating cause, microbiological agents, inflammatory biomarkers, and the presence of cardiac complications such as pulmonary hypertension and cor pulmonale.10,11 Recent evidence has highlighted the prognostic value of readily available inflammatory biomarkers—particularly neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP)—in risk stratification of AECOPD.12–14 The microbiological profile of AECOPD shows significant geographic variation, with Indian studies reporting a predominance of Gram-negative organisms, particularly Klebsiella pneumoniae, unlike Western literature where Haemophilus influenzae traditionally predominates.15,16 Despite the substantial COPD burden in Rajasthan—which has among the highest age-standardised COPD incidence rates in India4—comprehensive clinical profiling of AECOPD patients from this region remains limited. The present study was designed to systematically evaluate the clinical profile of AECOPD patients at a tertiary care hospital in Jaipur, encompassing demographic characteristics, risk factors, clinical presentation, inflammatory biomarkers, spirometric severity, microbiological profile, cardiac complications, and hospital outcomes.

Study Design: Prospective observational study.

 

Setting and Duration: Department of General Medicine, MGMC&H, Jaipur, Rajasthan, over 18 months. Approved by the IEC, MGMC&H, Jaipur. Conducted per Declaration of Helsinki and ICMR guidelines. Written informed consent obtained from all participants or legally authorised representatives.

 

Participants: 105 patients aged ≥40 years admitted with AECOPD (GOLD criteria). Exclusions: bronchial asthma, active pulmonary tuberculosis on treatment, bronchiectasis, interstitial lung disease, lung malignancy, and unstable cardiac conditions.

 

Data Collection: Demographics, smoking history (pack-years), biomass exposure, COPD duration, exacerbation history, comorbidities, clinical examination, laboratory investigations (CBC, DLC, NLR, PLR, ESR, CRP, ABG, RFT, LFT, RBS), spirometry (post-bronchodilator FEV₁, FEV₁/FVC), chest X-ray, ECG, 2D echocardiography (LVEF, PASP, cor pulmonale), sputum culture, and final outcome.

 

Statistical Analysis: SPSS; Mean ± SD for continuous, n (%) for categorical; Chi-square, Fisher’s exact, ANOVA; p<0.05 significant.

Table 1: Demographic and Risk Factor Profile (N=105)

Characteristic	Value
Age Distribution
Mean ± SD (Range)	60.30 ± 10.20 (40–80) years
40–49 years	20 (19.05%)
50–59 years	26 (24.76%)
60–69 years	40 (38.10%)
70–79 years	17 (16.19%)
≥80 years	02 (01.90%)
Gender (M:F = 5.2:1)
Male	88 (83.81%)
Female	17 (16.19%)
Smoking History
Ever-Smoker (Current + Ex)	68 (64.76%)
Mean Pack-Years	25.90 ± 10.30
Cigarette / Bidi / Hookah	33 (48.53%) / 30 (44.12%) / 05 (07.35%)
Never-Smoker	37 (35.24%)
Biomass Fuel Exposure
Present	29 (27.62%)
Mean Duration	17.90 ± 8.50 years
COPD Duration & Exacerbation History
Mean COPD Duration	7.70 ± 3.80 years
Mean Exacerbations/Year	2.40 ± 1.60
≥2 Exacerbations/Year	77 (73.33%)
≥2 Hospitalisations/Year	44 (41.90%)

 

The 60–69 years age group predominated (38.10%). The high proportion of ever-smokers (64.76%) with substantial pack-year burden, combined with 27.62% biomass exposure, reflects the dual risk factor profile characteristic of Rajasthan. The majority (73.33%) were frequent exacerbators.

 

Figure 1: Age Distribution of Study Population (N=105)

 

Table 2: Clinical Presentation and Physical Examination (N=105)

 

Dyspnoea was near-universal (99.05%). mMRC Grade 3–4 in 62.86% indicates severe functional limitation. The high prevalence of cyanosis (68.57%) and accessory muscle use (67.62%) reflects significant respiratory distress. Hypertension (46.67%) and diabetes (35.24%) were the commonest comorbidities.

 

Table 3: Laboratory and Inflammatory Parameters (N=105)

 

Neutrophilic leucocytosis was characteristic. Inflammatory biomarkers were uniformly elevated: mean NLR 6.40 (above the prognostic threshold of 5.67 reported by Chen et al.), CRP 44.10 mg/L (above the 30 mg/L threshold by Patil et al.). Type II respiratory failure was present in 40 (38.10%); overall respiratory failure in 58 (55.24%).

 

Table 4: Spirometric Severity, GOLD Classification, and Precipitating Factors (N=105)

GOLD Stage III–IV accounted for 62.86%, and 77.14% were Group D. Infective causes collectively precipitated 58.10% of exacerbations. Pulmonary TB (10.48%) as a precipitant reflects the high TB burden in India.

 

Figure 2: Causes of Acute Exacerbation (N=105)

 

Table 5: Cardiac Evaluation and Pulmonary Hypertension (N=105)

 

Pulmonary hypertension was present in 59.05% and cor pulmonale in 39.05%, reflecting advanced cardiopulmonary disease. P-pulmonale (51.43%) and RVH (49.52%) on ECG corroborated the echocardiographic findings.

D

Table 6: Sputum Culture and Microbiological Profile (N=105)

 

53.33% culture positivity rate is consistent with Groenewegen and Wouters (50%). Klebsiella pneumoniae predominance (30.36%) differs from Western literature (H. influenzae) and is consistent with Indian studies by Sharma et al. Gram-negative organisms predominated overall.

 

Figure 3: Sputum Culture Isolates (n=56)

 

Table 7: Hospital Course and Outcome (N=105)

 

In-hospital mortality was 15.24%, comparable to Kumar and Choubey (17%) and Suresh et al. (18.3%). All fatalities occurred in patients with respiratory failure requiring ventilatory support. The 29.52% invasive ventilation rate and 34.29% ICU admission rate reflect the severity of the admitted cohort.

 

Figure 4: Final Outcome (N=105)

Demographic Profile

The mean age of 60.30 ± 10.20 years is consistent with Patil et al.17 (62.1 years), Kumar and Choubey18 (62.4 years), and Ramakrishna et al.19 (64.2 years). The marginally lower mean age may reflect earlier disease onset in Rajasthan due to biomass exposure, bidi smoking, and occupational dust. Male predominance (83.81%) aligns with Patil et al.17 (88%), Kumar and Choubey18 (78.6%), and Suresh et al.20 (82.5%). The 27.62% biomass exposure rate, predominantly in females, is consistent with Sharma et al.21 (34.6% in 2,194 Indian COPD patients), who identified a distinct biomass-COPD phenotype with more small airway disease and earlier pulmonary hypertension.

 

Inflammatory Biomarkers

The elevated NLR (6.40 ± 5.30) exceeds the prognostic threshold of 5.67 reported by Chen et al.12 (AUC 0.801 for 28-day mortality). Jain et al.13 from Bikaner, Rajasthan, reported NLR 5.72 vs 3.77 in AECOPD vs stable COPD (AUC 0.782). Al-Lawati et al.14 documented NLR 6.84 and CRP 48.6 mg/L, with combined AUC 0.912. Wang et al.22 demonstrated NLR ≥4.43 independently predicted readmission (HR 1.78). Srinivas et al.23 showed progressive NLR increase across mild (4.12), moderate (6.78), and severe (9.56) AECOPD. The mean CRP of 44.10 mg/L exceeds the 30 mg/L threshold identified by Patil et al.24 as predicting adverse outcomes (OR 2.89). These findings support NLR and CRP as readily available prognostic tools in AECOPD.

 

Respiratory Failure and Pulmonary Hypertension

Respiratory failure in 55.24% with Type II predominance (38.10%) is consistent with the pathophysiology of severe COPD. Patil et al.17 documented respiratory failure in 33.8% with hypercapnia as an independent mortality predictor. Pulmonary hypertension in 59.05% and cor pulmonale in 39.05% exceed the ACURE registry10 (25.28% PHD), likely reflecting the advanced disease profile (62.86% GOLD III–IV) and biomass exposure. Kumar and Choubey18 reported cor pulmonale in 42.1%, comparable to our findings.

 

Microbiological Profile

The 53.33% culture positivity with Klebsiella pneumoniae predominance (30.36%) contrasts with Western literature where H. influenzae predominates. This mirrors Sharma et al.15 (K. pneumoniae 38.6%) and reflects the geographic variation in AECOPD bacteriology. Groenewegen and Wouters16 reported 50% positivity with H. influenzae (45%). This has direct implications for empirical antibiotic selection in Indian AECOPD patients—favouring agents with Gram-negative coverage.

 

Outcomes and Mortality

The 15.24% in-hospital mortality is concordant with Kumar and Choubey18 (17%) and Suresh et al.20 (18.3%). Liu et al.25 in their meta-analysis of 37 studies identified age (OR 1.45), pneumonia (OR 2.12), acidosis (OR 2.78), and mechanical ventilation (OR 4.23) as mortality predictors—all highly prevalent in our cohort. The mean hospital stay (10.20 days) is comparable to Sharma et al.26 (10.9 days). The 41.90% with ≥2 prior hospitalisations and 39.05% with cor pulmonale predict high readmission risk.

The clinical profile of AECOPD patients at our tertiary care centre in Rajasthan is characterised by advanced disease severity (77.14% GOLD Group D, 62.86% GOLD Stage III–IV), high inflammatory burden (mean NLR 6.40, CRP 44.10 mg/L), significant cardiac complications (59.05% pulmonary hypertension, 39.05% cor pulmonale), and a distinctive microbiological profile dominated by Klebsiella pneumoniae (30.36%). The in-hospital mortality of 15.24% underscores the need for early recognition, aggressive management including appropriate antibiotic selection guided by local microbiological patterns, biomarker-based risk stratification using NLR and CRP, echocardiographic assessment for pulmonary hypertension and cor pulmonale, and comprehensive post-discharge follow-up to reduce readmissions.

 

LIMITATIONS

1.             Single-centre design.

2.             Viral diagnostics not available; viral triggers may be underestimated.

3.             GOLD ABCD classification based on recall of pre-exacerbation symptoms.

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