acute exacerbations are the main cause of hospital admissions and hospitalizations in patients with copd in turkey . we aimed to determine the costs of hospitalization in patients with acute exacerbations of copd ( aecopd ) . a total of 7832 ( 1556 women , 6276 men ) patients were hospitalized due to acute exacerbations of copd between 20052009 in the samsun chest diseases and thoracic surgery hospital , northern turkey . the mean age was 64.6  19.8 years old and median length of hospital stay was 14.8  9.5 days . drug costs accounted for the largest portion ( 53.5% ) of the mean cost , followed by bed cost ( 19.6% ) . one hundred seventy - four ( 2.2% ) of the total hospitalized patients with aecopd died in hospital . although chronic obstructive pulmonary disease ( copd ) is a preventable and treatable disease , it remains a significant public health problem . copd is a major chronic cause of mortality and morbidity and it has been identified as the fourth leading cause of mortality and morbidity . unlike many leading causes of death and disability , copd is projected to increase in much of the world as smoking habits rise and the population ages.1,2 it was estimated by the world health organization ( who ) in 2000 that 274 million people worldwide died of copd.3 acute exacerbation is the main cause of hospitalization in patients with copd . the number of patients hospitalized for acute exacerbation of copd ( aecopd ) accounts for 13% of all admitted patients.4 it imparts a substantial economic burden on individuals and society . hospitalization for acute exacerbations represents a major component of the socioeconomic burden related to copd.5 hilleman et al reported that hospitalization costs represent 40.4% of total health care costs for patients with mild copd , and 62.6% of total costs for patients with severe copd.6 very few studies have quantified the economic and premature mortality associated with copd . the aim of this study was to determinate the costs of hospitalization in patients with aecopd . samsun chest diseases and thoracic surgery hospital is the reference hospital for chest diseases and thoracic surgery in northern turkey . diagnosis of aecopd ( emphysema and/or chronic bronchitis ) was based on the presence of any combination of the following symptoms : increased dyspnea and increased production and purulence of sputum that led to a change or increase in treatment . costs in this analysis were identified for drugs ( including short - acting and long - acting -agonists , ipratrobium , theophylline , inhaled and oral steroids , and antibiotics ) , oxygen therapy , non invasive mechanical ventilation , emergency department visit , laboratory tests , diagnostic tests , and hospitalizations . expenditure was calculated in us dollars ( exchange rate at the time of the study , 1.5 turkish liras per us dollar ) . a total of 60,529 patients with copd were seen in the samsun chest diseases and thoracic surgery hospital . 7832 ( 12.9% ) patients were hospitalized due to mild and moderate aecopd ; 19.8% of patients were women ( n = 1556 ) and 80.1% of patients were men ( n = 6276 ) . the numbers of patients hospitalized per year were 1061 , 1952 , 1794 , 1144 , and 1181 in 2005 , 2006 , 2007 , 2008 , and 2009 , respectively . the mean hospital costs per admission were $ 668 in 2005 , $ 765 in 2006 , $ 768 in 2007 , $ 667 in 2008 , and $ 682 in 2009 . drug costs were the highest ( 53.5% ) followed by bed cost ( 19.6% ) , laboratory ( 9.8% ) , radiology ( 6.2% ) , examination ( 4.6% ) and emergency department costs ( 3.9% ) , and other ( noninvasive ie , ventilation ) costs ( 2.4% ) . of the total hospitalized patients with aecopd , 174 ( 2.2% ) patients died in hospital . progressive respiratory failure , lung cancer , pulmonary infections , and cardiovascular comorbidities were major causes of death in hospitalized patients with aecopd . it is a costly disease with both direct costs ( value of health care resources devoted to diagnosis and medical management ) and indirect costs ( monetary consequences of disability , missed work , premature mortality , and caregiver or family costs resulting from the illness ) . according to reported articles , hospital admission rates are suitable for detecting the health burden of copd.4,7 acute exacerbations are the main cause of hospitalization in patients with copd . hospitalization - related costs are the largest portion of all expenditure for patients with copd . hospitalization costs represent between 40% and 57% of total direct costs generated by patients with copd.5,912 the exacerbations account for 35%45% of the total per capita health care costs for copd.4 hilleman et al reported that the hospitalization costs of patients with mild , moderate , and severe copd were $ 680 , $ 2,658 , and $ 6770 , respectively.6 recent studies showed that there are variable differences in mean costs of aecopd between countries . the cost of hospitalization for copd was calculated to be $ 7,100 in united states and $ 2,652 in spain . the mean costs of our study were lower than those of other studies.9 miravitlles et al noted the mean cost of aecopd was $ 239.7 for hospitalization for 15 days.4 in our study , the mean cost of hospitalization due to aecopd per admission was $ 718  364 between 2005 and 2009 . the reported studies presented different percentages of costs . according to one article in spain , reported the highest cost was hospitalization ( 58% ) and drug acquisition was 32.2%.10 in china , the highest absolute cost was drug cost ( 71.2% ) , followed by laboratory cost ( 16.7% ) , and bed cost was the lowest cost ( 4.1%).14 in the present study , the percentage of drug cost was the highest ( 53.5% ) , followed by bed cost ( 19.6% ) . we know that the different costs are related to the differences in reference prices ( drugs , laboratory ) , management practices , and health care systems.4 in turkey , the bed cost is lower , but drug prices are higher than in other european countries . furthermore , the mean cost of this study was lower than reported studies because patients who needed the intensive care unit ( icu ) were not included in this study . nurmagambetov et al reported the estimated copd - related total medical costs per patient decreased 22% largely with a decrease in the cost of hospitalizations for copd.15 although many investigatons have found inpatient mortality rates associated with copd exacerbations to be between 2.5% and 4% , gold has reported an overall rate of 10% , which increases to 40% in 1 year.18,19 groenewegen et al reported the mortality rate during hospital stay was 8%.8 we detected a premature mortality rate during hospitalization of 2.2% in patients with aecopd . our result was lower than in other studies because the patients who needed intensive care were not included this study . ( the patients who needed intensive care were referred to the university hospital ) . in the present study , progressive respiratory failure , lung cancer , pulmonary infections , and cardiovascular comorbidities appear to be major causes of death in hospitalized patients . other studies reported in - hospital mortality rates 11%24%.7,16,17 in these studies , the high mortality rates were caused by mechanical ventilation and icu . in conclusion , acute exacerbations of copd continues to have both significant economic burden and high mortality rate .
introduction : chronic obstructive pulmonary disease ( copd ) is a major public health problem . 
 it imparts a substantial economic burden on individuals and society . 
 acute exacerbations are the main cause of hospital admissions and hospitalizations in patients with copd in turkey.objectives:we aimed to determine the costs of hospitalization in patients with acute exacerbations of copd ( aecopd).results : a total of 7832 ( 1556 women , 6276 men ) patients were hospitalized due to acute exacerbations of copd between 20052009 in the samsun chest diseases and thoracic surgery hospital , northern turkey . 
 the mean age was 64.6  19.8 years old and median length of hospital stay was 14.8  9.5 days . 
 the mean cost per admission was us$718  364 . 
 drug costs accounted for the largest portion ( 53.5% ) of the mean cost , followed by bed cost ( 19.6% ) . 
 one hundred seventy - four ( 2.2% ) of the total hospitalized patients with aecopd died in hospital.conclusion:aecopd continues to have both significant economic burden and high mortality rate .