Open Access Open Badges Study protocol

Incidence and risk factors of exacerbations among COPD patients in primary health care: APMPOC study

Eulàlia Borrell1, Mar Rodríguez2, Pere Torán36*, Laura Muñoz3, Guillem Pera3, Núria Montellà4, Mònica Monteagudo5, Magalí Urrea3, Yolanda Puigfel3, Antonio Negrete6, Xavier Mezquiriz1, Cristina Domènech1, Anna Lacasta1, Ma Llum García1, Sandra Maneus1 and Glòria Tintoré7

Author Affiliations

1 Primary Healthcare Centre Sant Roc, Catalan Health Institute, Velez Rubio s/n, 08913 Badalona, Spain

2 Primary Healtcare Centre Canet de Mar, Catalan Health Institute, Costa de l'Hospital s/n, 08640 Canet de Mar, Spain

3 Primary Healthcare Research Support Unit Barcelonès Nord i Maresme. IDIAP Jordi Gol, Camí del Mig 36 (3a planta), 08303 Mataró, Spain

4 Primary Healthcare Methodology, Quality and Evaluation Unit Badalona i Sant Adrià de Besòs, Catalan Health Institute, Plaça de la Medicina, s/n, 08911 Badalona, Spain

5 Primary Healthcare Research Support, IDIAP Jordi Gol. Avda, Gran Via de les Corts Catalanes 487, 08007 Barcelona, Spain

6 Primary Healthcare Centre Gatassa, Catalan Health Institute, Camí del Mig 36 (4a planta), 08303 Mataró, Spain

7 Primary Healthcare Centre Llefià, Catalan Health Institute, Carretera Antiga de València s/n, 08913 Badalona, Spain

For all author emails, please log on.

BMC Public Health 2009, 9:8  doi:10.1186/1471-2458-9-8

Published: 9 January 2009



Worldwide, chronic obstructive pulmonary disease (COPD) is the fourth cause of death. Exacerbations have a negative impact on the prognosis of COPD and the frequency and severity of these episodes are associated with a higher patient mortality. Exacerbations are the first cause of decompensation, hospital admission and death in COPD. The incidence of exacerbations has mainly been estimated in populations of patients with moderate-severe COPD requiring hospital care. However, little is known regarding the epidemiology of exacerbations in patients with less severe COPD forms. It is therefore possible that a high number of these less severe forms of exacerbations are underdiagnosed and may, in the long-term, have certain prognostic importance for the COPD evolution. The aim of this study was to know the incidence and risk factors associated with exacerbations in patients with COPD in primary care.

Methods and design

A prospective, observational, 3-phase, multicentre study will be performed involving: baseline evaluation, follow up and final evaluation. A total of 685 smokers or ex-smokers from 40 to 80 years of age with COPD, without acute respiratory disease or any other long-term respiratory disease will be randomly selected among the population assigned to 21 primary care centres. The diagnosis of COPD and its severity will be confirmed by spirometry. Information regarding the baseline situation, quality of life and exposure to contaminants or other factors potentially related to exacerbations will be collected. A group of 354 patients with confirmed COPD of varying severity will be followed for one year through monthly telephone calls and daily reporting of symptoms with the aim of detecting all the exacerbations which occur. These patients will be evaluated again at the end of the study and the incidence of exacerbations and associated relative risks will be estimated by negative binomial regression.


The results will be relevant to provide knowledge about natural history of the initial phases of the COPD and the impact and incidence of the exacerbations on the patients with mild-moderate forms of the disease. These data may be important to know the milder forms of exacerbation wich are often silent or very little expressed clinically.