Prevalence and clinical significance of fever in acute exacerbations of chronic obstructive pulmonary disease

Fever is an important, although not always present, sign in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The objective of this study was to determine the prevalence of fever and its clinical significance in these episodes. Two hundred seventeen AECOPD hospitalizations were included in a prospective study and were categorized as febrile (FH) or afebrile (AFH), using as a cutoff a rectal temperature measurement of 37.8°C during hospitalization. Eighty-six hospitalizations (39.6%) were identified as AFH. The patients in this group had significantly more severe airway obstruction and hypoxemia, a higher rate of chronic obstructive pulmonary disease (COPD) complications, a higher rate of type 3 exacerbation, a shorter length of hospitalization and a higher rate of readmissions than patients in the FH group. The results of this study show that more than one-third of AECOPD hospitalizations are attributable to afebrile episodes. These episodes are characterized by lower rates of bronchitis manifestations in patients with more severe disease. Although the length of hospitalization for these episodes is shorter, the readmission rate is higher.