Chronic Obstructive Pulmonary Disease Admissions Research Articles

A prospective study on direct out-of-pocket expenses of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in a Philippine tertiary care center

Chronic obstructive pulmonary disease (COPD) is a frequent cause of morbidity and mortality in the Philippines and majority of the economic burden lies in hospitalizations during an exacerbation. Despite coverage of hospitalization cost with the national health insurance system (Phil-Health) for COPD exacerbations, patients often pay out-of-pocket. This study aimed to determine the demographic characteristics of COPD admissions at a Philippine tertiary care center, Philippine General Hospital, and assess mean cost of hospitalization, and identify predictors of prolonged hospitalization and cost > 20,000 Philippine pesos (Php). A prospective cross-sectional study was conducted for 6 months by chart review. Patients were categorized as charity service patients, that is, with no charged professional fees and free medications and private service patients who pay for their health care services. A total of 43 COPD admissions were included. The average daily cost of hospitalization (at peso-dollar rate of 56) for service patients was at $ 75.89 compared to private service patients at $ 285.71. Demographic characteristics and type of accommodation were not significant predictors of prolonged hospital stay nor hospitalization cost of ≥ $ 357. Accommodation cost and professional fees accounted for majority or 61.6% of the overall cost for private patients, while medications and diagnostic tests were the major or 76.01% contributor to the overall cost for charity patients. Despite existence of Phil-health, in-patient coverage for COPD remain insufficient. Measures for maximizing COPD control in the out-patient setting could potentially reduce total cost for this disease.

Assessment of the Relationship Between Genetic Determinants of Obesity, Unhealthy Eating Habits and Chronic Obstructive Pulmonary Disease: A Mendelian Randomisation Study

Background: Clinical studies have shown that the onset and exacerbation of chronic obstructive pulmonary disease (COPD) are related to obesity and dietary behaviours, but the genetic relationship between them is not clear. Aims: To investigate the relationship between the genetic determinants of obesity, dietary habits (alcohol consumption, intake of sweets, salt intake) and COPD. Methods: Exposure and outcome datasets were obtained from the IEU Open GWAS project. The exposure dataset includes dietary habits (Salt added to food, Sweets intake, Alcohol consumption), obesity level (represented by body mass index (BMI) and body fat percentage (BFP) data sets.). The outcome dataset includes COPD and acute COPD admissions. The collected data were imported into the RStudio software and conducted Mendelian randomisation analysis. Additionally, heterogeneity and horizontal pleiotropy tests were conducted on the data to ensure the veracity of the results. Results: The results showed that BMI was positively correlated with the risk of acute COPD admission (OR = 1.74, 95% CI 1.39–2.18) and COPD (OR = 1.81, 95%CI 1.41–2.33). In addition, BFP was also a risk factor for COPD (OR = 1.98, 95% CI 1.42–2.77) and acute exacerbation of COPD admission (OR = 1.99, 95%CI 1.43–2.77). The increase of salt, sugar and alcohol consumption will not increase the risk of COPD and the risk of hospitalisation due to COPD. Conclusion: Therefore, we should strengthen the guidance of diet and living habits of obese patients. For patients with heavier weight and higher body fat rate, they should be instructed to lose weight and fat to prevent the occurrence of COPD. For obese patients with COPD, more attention should be paid to prevent the occurrence of acute exacerbation of COPD in advance.

Variations in avoidable hospital admissions and emergency visits by primary care characteristics: an ecological study in Italy.

Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on the correlation between the characteristics of primary healthcare across Italian regions and health outcomes included in the National Programs Outcomes of the National Agency for Regional Healthcare Services. Ecological study. We analysed healthcare data from the National Agency for Regional Healthcare Services, the public lists of primary care doctors and the National Federation of Surgeons and Dentists and the National Institutes of Statistics referring to the 20 Italian regions. Pearson's correlation and Spearman's correlation were used to assess the relationships between primary healthcare characteristics and health outcomes. Overall, across all Italian regions each general practitioner had on average 1447 patients and was 57.5 years old. The study found positive correlations between the number of patients per general practitioner and non-urgent Emergency Department visits among adult patients (Pearson's r = 0.58, p = 0.008), the number of residents aged 65+ per general practitioner and the rate of chronic obstructive pulmonary disease admissions (Pearson's r = 0.49, p = 0.029), and the age of general practitioners and lower-extremity amputations in diabetes patients (Pearson's r = 0.56, p = 0.011). A negative correlation was observed between the age of general practitioners and urinary tract infection admissions (Pearson's r = -0.76; p < 0.001). A non-linear negative correlation was found between the age of general practitioners and chronic obstructive pulmonary disease admissions (Spearman's ρ = -0.46, p = 0.041). The findings emphasise the importance of guaranteeing sufficient numbers of primary healthcare physicians to meet patients' needs, and for limiting avoidable hospitalisations and emergency presentations. General practitioners' age might also influence the provision of care, but more research is needed on possible mechanisms.

The impact of air pollution on hospitalization for COPD patients in China.

With the rapid development of the global economy and the acceleration of urbanization, air pollution has become a major environmental problem threatening human health. There is limited evidence on the acute effects of air pollution on chronic obstructive pulmonary disease (COPD). From 2014 to 2019, we collected data on daily admissions for COPD patients from a city in China. We used the generalized additive model together with distributed lag models to fit the associations of air pollutants with hospital admissions. We observed significant increments in the number of daily admissions (0.086-0.109%) for COPD for a unit range increase in air quality index, PM2.5 and PM10 over four lag days. The impact of air pollution on the number of daily admissions was mainly reflected in the COPD patients who were hospitalized through outpatient departments and tertiary hospitals. Short-term exposure to outdoor air pollution may induce the occurrence or exacerbation of COPD patients; therefore, government departments should strengthen the management of air pollution, improve supervision and control mechanisms, pay attention to the quality of medical services, and reduce the adverse effects of air pollution on patients' health.

Measuring disparities in virtual healthcare and outcomes in chronic obstructive pulmonary disease patients during the COVID-19 pandemic.

The use of virtual healthcare increased with the COVID-19 pandemic, even among chronic obstructive pulmonary disease (COPD) patients. We measured disparities in virtual compared to traditional healthcare and outcomes in COPD patients during the pandemic. This study retrospectively identified adult patients with virtual or in-person primary care encounters at a large, Midwestern hospital system between March 1, 2020, and June 30, 2020. Data regarding age, sex, race, smoking, area deprivation index (ADI), COPD diagnosis, visit type (office, telephone, video, E-visit, virtual, or hybrid of office and virtual), and time to hospital admission in the following 12 months were collected. Analysis was performed using chi-square, analysis of variance, Kruskal-Wallis rank sum, and Cox proportional modeling. This study identified 86,715 patients. Of those, 4702 had COPD and were more likely to be 65 years or older, White, have higher ADI, use telephone or hybrid visits compared to the rest of the study population and majority had smoking history. Office, telephone, and hybrid visits were used frequently, consistently seen across sex, race, ADI, and smoking categories. Increasing age was associated with increased use of office and telephone visits, and decreased use of video visits. Higher ADI was associated with telephone visits, and lower ADI was associated with video visits. There were no significant differences in overall, COPD, or COVID-19 hospital admission rates across visit types. Complex disparities in utilizing traditional healthcare are also reflected in virtual healthcare in COPD patients, and do not significantly affect hospital admissions.

Trends in hospital admissions for chronic obstructive pulmonary disease over 16 years in Canada.

Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition, and the rate of hospital admissions for COPD is an indicator of the quality of outpatient care. We sought to determine long-term trends in hospital admissions for COPD in Canada. Using a comprehensive national database of hospital admissions in Canada, we identified those with a main discharge diagnosis of COPD for patients aged 40 years and older between 2002 and 2017. We calculated sex-specific, age-standardized trends in annual rates of hospital admissions for COPD separately for younger (40-64 yr) and older adults (≥ 65 yr). We used spline regression to examine changes in the admissions trends for each sex and age group. Over 16 years, 1 134 359 hospital admissions were for COPD. Between 2002 and 2017, the total number of admissions increased by 68.8%, from 52 937 to 89 384. The overall crude admission rate increased by 30.0%, from 368 to 479 per 100 000 population, and the sex-and age-standardized admission rate increased by 9.6%, from 437 to 479 per 100 000 population. Age-standardized rates increased by 12.2% among younger females, by 24.4% among younger males and by 29.8% among older females, but decreased by 9.0% among older males. Over the same period, the all-cause sex-and age-standardized admission rate declined by 23.0%. Hospital admissions for COPD have increased since 2010, even after adjusting for population growth and aging, and despite declining rates of all-cause hospital admissions. The secular increase in COPD admissions indicates that the burden of COPD on Canadian health care systems is increasing.

Adherence to the Canadian Thoracic Society Chronic Obstructive Pulmonary Disease Pharmacotherapy Guidelines in a real-world hospital setting

RATIONALE The Canadian Thoracic Society (CTS) publishes chronic obstructive pulmonary disease (COPD) guidelines with recommendations regarding which inhaled pharmacotherapy to prescribe. A minimal amount is known about the implementation of these guidelines in routine clinical practice. OBJECTIVES The main goals of this review were to assess the adherence to the CTS COPD pharmacotherapy guidelines in a real-world setting of patients with a severe exacerbation, to determine predictors of increased guidelines adoption, and to review if subjects leaving the hospital without recommended inhaled therapy had a higher rate of readmission for COPD within 30 days. METHODS Patients treated in 2022 at Montfort Hospital for a COPD exacerbation (hospitalization or emergency department) were reviewed. Medication lists at the time of presentation and discharge were charted in addition to patient clinical characteristics and COPD admissions up to 30 days after the initial assessment. A comparison of COPD patients with and without recommended inhaled therapy optimization was performed. MEASUREMENTS AND MAIN RESULTS A total of 214 patients were admitted for a COPD exacerbation. From this sample, 111 were candidates for review of their inhaled therapy as per the CTS guidelines; however, only 22 (20%) received recommended optimization. Subjects who were admitted to inpatient units and those with spirometry results on file were more likely to receive appropriate pharmacotherapy at discharge (both p = 0.02). Patients not optimized as per the guidelines were at higher risk of readmission for a COPD exacerbation within 30 days (p = 0.02). CONCLUSIONS Adherence to the CTS COPD pharmacotherapy guidelines was low in a real-world hospital setting. Interventions that would help increase their adoption would result in improved patient outcomes.

Impact of COVID-19 and lockdown on COPD admissions to Christchurch Hospital, New Zealand 2020-2021: a combined quantitative and qualitative study.

During the year following New Zealand's first COVID-19 lockdown, a 33% reduction in chronic obstructive pulmonary disease (COPD)-related admissions occurred and persisted beyond this period at Christchurch Hospital. To identify contributing factors which may have resulted in a persistent decrease in COPD hospitalisation rates at Christchurch Hospital following the 2020 COVID-19 lockdown. Using an explanatory sequential mixed-methods research design, we (i) retrospectively analysed hospital admissions and primary healthcare access by people with COPD (n = 1358) in Canterbury before, during and after COVID lockdown (24 March 2019 to 2021) and (ii) undertook individual interviews from a sample of patients (n = 14). Patients who were not re-admitted following the COVID-19 lockdown had fewer general practice encounters, acute primary care access, antibiotic and prednisone prescriptions. Proportionally fewer Māori and more Pacific patients were admitted with COPD following lockdown. Positive contributing factors at a primary care level included improvements in primary care interactions and medication management. At a patient and community level, there were improvements in lifestyle, self-management practices, social support and contact precautions. However, a subgroup of patients described negative effects such as social isolation. A combination of patient, primary care and community-level factors led to an overall persistent decrease in COPD admissions following the COVID-19 lockdown. Future targeted and individualised measures focusing on these modifiable factors may decrease future COPD-related hospital admissions. The study design facilitated further explanation about factors that contributed to the persistent decrease in hospital admissions among people living with COPD and has underscored the importance of social support, patient empowerment and reduction in barriers in accessing care in admission reduction.

Application of mendelian randomization to study the causal relationship between smoking and the risk of chronic obstructive pulmonary disease.

Smoking is a risk factor for chronic obstructive pulmonary disease (COPD). Few studies have assessed the causal relationship between smoking and COPD using Mendelian randomization. Exposure and outcome datasets were obtained from the IEU Open GWAS project (https://gwas.mrcieu.ac.uk/). The exposure data set includes smoking (ever smoke, smoking/smokers in household, exposure to tobacco smoke at home). The outcome data set includes COPD susceptibility and acute COPD admissions. The main methods of Mendelian randomization analysis are weighted median method and MR-Egger method. Heterogeneity and polymorphism analyses were performed to ensure the accuracy of the results. ever smoke increased the risk of COPD prevalence, and ever smoke and smoking/smokers in household increased the risk of acute COPD admission. Conclusion Therefore, we should enhance the management of nonpharmacological prescription of COPD to reduce the individual incidence.

Hospital Burden of Chronic Obstructive Pulmonary Disease in Hong Kong - The Trend from 2006 to 2014.

Chronic obstructive pulmonary disease (COPD) is a common cause for hospital admission. This study aims to review the hospital burden of COPD in Hong Kong (HK) and the trend from year 2006 to 2014. A multi-center, retrospective study of the characteristics of COPD patients discharged from the public hospitals of HK from year 2006 to 2014. Anonymized data retrieval and analysis were performed. The demographic data of the subjects, use of health-care resources, ventilatory support, medications used and mortality of the subjects were analyzed. Total patient headcount (HC) and admission number reduced from 10,425 and 23,362 in year 2006 to 9613 and 19,771, respectively, in 2014. There was a progressive reduction of female COPD HC from 2193 (21%) in year 2006 to 1517 (16%) in 2014. The utilization of non-invasive ventilation (NIV) increased rapidly and peaked in 2010 (29%) and decreased thereafter. There was a rapid increase in the prescription of long-acting bronchodilators (from 15% to 64%). COPD and pneumonia were the top causes of death, but death due to pneumonia was rapidly increasing while death due to COPD was progressively decreasing over the period. COPD HC and admission number (particularly in female patients) decreased progressively from year 2006 to 2014. There was also a decreasing trend of severity of disease as reflected by lower NIV use (after year 2010) and lower mortality rate due to COPD. Reduced smoking prevalence and tuberculosis (TB) notification rate in the community in the past might have reduced the incidence and severity of COPD and the hospital burden of disease. We observed an increasing trend of mortality due to pneumonia in COPD patients. Appropriate and timely vaccination programs are recommended for COPD patients as in the general elderly population.

Short-Term Effects of Carbon Monoxide on Morbidity of Chronic Obstructive Pulmonary Disease With Comorbidities in Beijing.

The association between CO and chronic obstructive pulmonary disease (COPD) has been widely reported; however, the association among patients with type 2 diabetes mellitus (T2DM) or hypertension has remained largely unknown in China. Over-dispersed generalized additive model was adopted to quantity the associations between CO and COPD with T2DM or hypertension. Based on principal diagnosis, COPD cases were identified according to the International Classification of Diseases (J44), and a history of T2DM and hypertension was coded as E12 and I10-15, O10-15, P29, respectively. A total of 459,258 COPD cases were recorded from 2014 to 2019. Each interquartile range uptick in CO at lag 03 corresponded to 0.21% (95%CI: 0.08%-0.34%), 0.39% (95%CI: 0.13%-0.65%), 0.29% (95%CI: 0.13%-0.45%) and 0.27% (95%CI: 0.12%-0.43%) increment in admissions for COPD, COPD with T2DM, COPD with hypertension and COPD with both T2DM and hypertension, respectively. The effects of CO on COPD with T2DM (Z=0.77, P=0.444), COPD with hypertension (Z=0.19, P=0.234) and COPD with T2DM and hypertension (Z=0.61, P=0.543) were insignificantly higher than that on COPD. Stratification analysis showed that females were more vulnerable than males except for T2DM group (COPD: Z=3.49, P<0.001; COPD with T2DM: Z=0.176, P=0.079; COPD with hypertension: Z=2.48, P=0.013; COPD with both T2DM and hypertension: Z=2.44, P=0.014); No statistically significant difference could be found between age groups (COPD: Z=1.63, P=0.104; COPD with T2DM: Z=0.23, P=0.821; COPD with hypertension: Z=0.53, P=0.595; COPD with both T2DM and hypertension: Z=0.71, P=0.476); Higher effects appeared in cold seasons than warm seasons on COPD (Z=0.320, P<0.001). This study demonstrated an increased risk of COPD with comorbidities related to CO exposure in Beijing. We further provided important information on lag patterns, susceptible subgroups, and sensitive seasons, as well as the characteristics of the exposure-response curves.

A Prospective Study on Direct Out-of-Pocket Expenses of Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Philippine tertiary care center

Chronic obstructive pulmonary disease (COPD) is a frequent cause of morbidity and mortality in the Philippines and the majority of the economic burden lies in hospitalizations during an exacerbation. Despite coverage of hospitalization costs with the national health insurance system (PhilHealth) for COPD exacerbations, patients often pay out-of-pocket. This study aimed to determine the demographic characteristics of COPD admissions at a Philippine tertiary care center, Philippine General Hospital, assess the mean cost of hospitalization, and identify predictors of prolonged hospitalization and cost &gt;20,000 Philippine pesos (Php). A prospective cross-sectional study was conducted for 6 months by chart review. Patients were categorized as charity service patients, that is, with no charged professional fees and free medications and private service patients who pay for their health care services. A total of 43 COPD admissions were included. The average daily cost of hospitalization (per 1,000 pesos) for service patients was 4.25, compared to 16 for private service patients. Demographic characteristics and type of accommodation were not significant predictors of prolonged hospital stay nor hospitalization cost of &gt; Php 20,000. Accommodation costs and professional fees accounted for the majority of the overall cost for private patients, while medications and diagnostic tests were the major contributors to the overall cost for charity patients. Despite the existence of PhilHealth, in-patient coverage for COPD remain insufficient. Measures for maximizing COPD control in the outpatient setting could potentially reduce the total cost of this disease.

Trends in hospital admissions and prescribing due to chronic obstructive pulmonary disease and asthma in England and Wales between 1999 and 2020: an ecological study

ObjectiveTo investigate the trends in hospital admissions and medication prescriptions related to asthma and chronic obstructive pulmonary disease (COPD) in England and Wales.MethodsAn ecological study was conducted between April 1999 and April 2020 using data extracted from the hospital episode statistics database in England and the patient episode database for Wales. The Office of National Statistics mid-year population estimates for 1999 through 2020 were collected, and medication prescription data for 2004–2020 were extracted from the prescription cost analysis database.ResultsThe total annual number of COPD and asthma hospital admissions for various causes increased by 82.2%, from 210,525 in 1999 to 383,652 in 2020, representing a 59.1% increase in hospital admission rate (from 403.77 in 1999 to 642.42 per 100,000 persons in 2020, p < 0.05). Chronic obstructive pulmonary disease with acute lower respiratory infection accounted for 38.7% of hospital admissions. Around 34.7% of all hospital admissions involved patients aged 75 and older. Around 53.8% of all COPD and asthma hospital admissions were attributable to females. The annual number of prescriptions dispensed for COPD and asthma medications increased by 42.2%.ConclusionsThroughout the study period, hospital admissions due to chronic obstructive pulmonary disease and asthma, as well as medication prescriptions, increased dramatically among all age groups. Hospitalization rates were higher for women. Further observational and epidemiological research is required to identify the factors contributing to increased hospitalization rates.

Associations between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Jinan: potential benefits from air quality improvements.

Evidence between air pollution and chronic obstructive pulmonary disease (COPD) is inconsistent and limited in China. In this study, we aim to examine the associations between air pollutants and hospital admissions for COPD, hoping to provide practical advice for prevention and control of COPD. Hospital admissions for COPD were collected from a Grade-A tertiary hospital in Jinan from 2014 to 2020. A generalized additive model (GAM) was used to examine the associations between air pollutants and hospital admissions for COPD. Stratified analysis was also conducted for gender, age (20-74 and ≥75 years), and season (warm and cold). The avoidable number of COPD hospital admissions was calculated when air pollutants were controlled under national and WHO standards. Over the study period, a total of 4,012 hospital admissions for COPD were recorded. The daily hospital admissions of COPD increased by 2.36% (95%CI: 0.13-4.65%) and 2.39% (95%CI: 0.19-4.65%) for per 10 μg/m3 increase of NO2 and SO2 concentrations at lag2, respectively. There was no statistically significant difference in health effects caused by increased concentrations of PM2.5, PM10, CO, and O3. The health effects of increased SO2 concentration were stronger in women, the ≥75 years old people and the cold season. About 2 (95%CI: 0-3), 64 (95%CI: 4-132) and 86 (95%CI: 6-177) COPD admissions would be avoided when the SO2 concentration was controlled below the NAAQS-II (150 μg/m3), NAAQS-I (50 μg/m3), and WHO's AQG2021 standard (40 μg/m3), respectively. These findings suggest that short-term exposure to NO2 and SO2 was associated with increased risks of daily COPD admissions, especially for females and the elderly. The control of SO2 and NO2 under the national and WHO standards could avoid more COPD admissions and obtain greater health benefits.

Environmental pollution in North-Eastern Italy and its influence on chronic obstructive pulmonary disease: time series modelling and analysis using visibility graphs

The impact on human health from environmental pollution is receiving increasing attention. In the case of respiratory diseases such as chronic obstructive pulmonary disease (COPD), the relationship is now well documented. However, few studies have been carried out in areas with low population density and low industrial production, such as the province of Belluno (North-Eastern Italy). The aim of the study was to analyze the effect of exposure to certain pollutants on the temporal dynamics of hospital admissions for COPD in the province of Belluno. Daily air pollution concentration, humidity, precipitations, and temperature were collected from the air monitoring stations in Belluno. Generalized additive mixed models (GAMM) and visibility graphs were used to determine the effects of the short-term exposure to environmental agents on hospital admissions associated to COPD. In the case of the city of Belluno, the GAMM showed that hospital admissions were associated with NO2, PM10, date, and temperature, while for the city of Feltre, GAMM produced no associated variables. Several visibility graph indices (average edge overlap and interlayer mutual information) showed a significant overlap between environmental agents and hospital admission for both cities. Our study has shown that visibility graphs can be useful in establishing associations between environmental agents and COPD hospitalization in sparsely populated areas.

Impact of removing prescription co-payments on the use of costly health services: a pragmatic randomised controlled trial

ObjectivesTo determine whether exempting people (with high health needs and living in areas of high deprivation) from a $5 prescription charge reduces hospital use.DesignTwo-group parallel prospective randomised controlled trial.SettingPeople living in the community in various regions of New Zealand.ParticipantsOne thousand sixty one people who lived in areas of high socioeconomic deprivation, and either took medicines for diabetes, took antipsychotic medicines, or had chronic obstructive pulmonary disease (COPD). Of the 1053 who completed the study, just under half (49%) were Māori. InterventionsParticipants were individually randomized (1–1 ratio) to either be exempted from the standard $5 charge per prescription item for one year (2020-2021) (n = 591) or usual care (n = 469). Those in the intervention group did not pay the standard NZ$5 charge, and pharmacies billed the study for these. Participants continued to pay any other costs for prescription medicines. Those in the control group continued to pay all prescription charges for the year although they may have received one-off assistance from other agencies.Main outcome measuresThe primary outcome was length of stay (hospital bed-days). Secondary outcomes presented in this paper included: all-cause hospitalisations, hospitalisations for diabetes/mental health problems/COPD, deaths, and emergency department visits.ResultsThe trial was under-powered because the recruitment target was not met. There was no statistically significant reduction in the primary outcome, hospital bed-days (IRR = 0.68, CI: 0.54 to 1.05). Participants in the intervention group were significantly less likely to be hospitalised during the study year than those in the control group (OR = 0.70, CI: 0.54 to 0.90). There were statistically significant reductions in the number of hospital admissions for mental health problems (IRR = 0.39, CI: 0.17 to 0.92), the number of admissions for COPD (IRR = 0.37, CI: 0.16 to 0.85), and length of stay for COPD (IRR 0.20, CI: 0.07 to 0.60). Apart from all-cause mortality and diabetes length of stay, all measures were better for the intervention group than the control group.ConclusionsEliminating a small co-payment appears to have had a substantial effect on patients’ risk of being hospitalised. Given the small amount of revenue gathered from the charges, and the comparative large costs of hospitalisations, the results suggest that these charges are likely to increase the overall cost of healthcare, as well as exacerbate ethnic inequalities.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001486213 registered on 04/09/2018.

Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD.

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of acquiring severe coronavirus disease 2019 (COVID-19), which is why self-isolation was recommended. However, long periods of social isolation, accompanied by limited access to health care systems, might influence the outcome of patients with severe COPD negatively. Data from COPD and pneumonia patients at Charité-Universitätsmedizin Berlin and the volume of endoscopic lung volume reduction (ELVR) surgeries from the German Lung Emphysema Registry (Lungenemphysem Register e.V.) were analyzed from pre-pandemic (2012 to 2019) to the pandemic period (2020 and 2021). In addition, 52 patients with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 4 status included in the lung emphysema registry received questionnaires during lockdowns from June 2020 to April 2021. Admissions and ventilation therapies administered to COPD patients significantly decreased during the COVID-19 pandemic. Likewise, there was a reduction in ELVR treatments and follow-ups registered in German emphysema centers. Mortality was slightly higher among patients hospitalized with COPD during the pandemic. Increasing proportions of COPD patients with GOLD stage 3 and GOLD stage 4 status reported behavioral changes and subjective feelings of increasing COPD symptoms the longer the lockdown lasted. However, COPD symptom questionnaires revealed stable COPD symptoms over the pandemic time period. This study reveals reduced COPD admissions and elective treatment procedures of COPD patients during the pandemic, but a slight increase in mortality among patients hospitalized with COPD, irrespective of COVID-19. Correspondingly, patients with severe COPD reported subjective deterioration of their health status, probably caused by their very strict compliance with lockdown measures.

Assessing the impact of COVID-19 measures on COPD management and patients: a simulation-based decision support tool for COPD services in the UK

ObjectivesTo develop a computer-based decision support tool (DST) for key decision makers to safely explore the impact on chronic obstructive pulmonary disease (COPD) care of service changes driven by restrictions...

DIFFERENCES IN OUTCOMES OF COPD EXACERBATIONS WITH DEGREE OF HYPERCAPNIA: AN OBSERVATIONAL PERSPECTIVE

SESSION TITLE: COPD Outcomes from the Hospital to HomeSESSION TYPE: Original InvestigationsPRESENTED ON: 10/17/22 1:30 PM - 2:30 PMPURPOSE: Various mechanisms for hypercapnia (HC) in chronic obstructive pulmonary disease (COPD) have been established. However, characteristics of COPD exacerbation patients, degree of hypercapnia, and the outcomes like mortality and readmissions if determined can improve disposition and improve morbidity of the patients.METHODS: Geisinger Health System admissions between 2016 and 2020 with COPD exacerbation were selected. Inclusion criteria included principal diagnosis of COPD, age >18 years, had arterial blood gas, pulmonary function tests, and received steroids during the hospitalization. Cox regression model and GEE logistic model were used to determine the characteristics including demographics, comorbidities, and odds for outcomes of COPD-HC (pCO2 >52) vs non-HC (pCO2 <52) group.RESULTS: Out of the total 140,947 COPD admissions, 5606 encounters met inclusion, with 2706 unique patients. Of 2706, 59.2 % (n=1603) had 1 encounter and 1.7% (n=45) had 10 or more encounters. We compared characteristics of COPD-HC, defined as PaCO2 >=52 (n (n= 2355) and non-HC defined as PaCO2 < 52(n= 3251). The median age was 66.7 years in the HC group and 68.8 years in the non-HC group (p=0.2355). Both HC and non-HC cohorts were not statistically different by age, gender, race, BMI, alcohol use, drug use, smoking, and tobacco use. HC group more often had heart failure (65% vs 56.3%), OSA (44.2% vs vs33.4%), and less often had CKD (32% vs 42.4%) than the non-HC group (p<0.05). The HC group had higher use of inhalers including LAMA (21.6% vs 17.9%), ICS (56.5% vs 43.4%), and LABA (32.7% v/s 29.9%) than the non-HC group (p<0.05). FEV1/FVC ratio [45 vs 54], actual FEV1 [0.76 vs 1.14], percent FEV1 [30 vs 46], actual FVC [1.68 vs 2.25] and percent FVC [50 vs 66] showed greater obstruction in the HC group than the non-HC group (p <0.0001). HC group had significantly higher odds of mortality inpatient [OR 1.58 (1.05, 2.39)], within 30 days of admission [OR 1.65 (1.31, 2.09)] and discharge [OR 1.65 (1.30, 2.10)], and within 60 days of admission [OR 1.61 (1.31, 1.97)] and discharge [OR 1.48 (1.20,1.82)] (p<0.05). The odds of readmissions within both groups did not show any significant difference. HC admissions had prolonged hospital stay compared to non-HC admissions (5.42 vs 4.45 days, p<0.05).CONCLUSIONS: In our single-center analysis of COPD exacerbations, patients with hypercapnia were more likely to have marked airflow limitation by pulmonary function testing, more likely to have comorbid heart failure and sleep apnea. Hypercapnic patients had higher in-hospital, 30-day, and 60-day mortality, but did not influence readmission rates.CLINICAL IMPLICATIONS: Our study indicates that HC-COPD hospitalizations are likely due to the disease pathology, thus, remedies like Bipap may not be appropriate. Further prospective trials are necessary to understand the disease process and provide just care to COPD patients with hypercapnia.DISCLOSURES: No relevant relationships by Andrea BergerNo relevant relationships by Zainab GandhiNo relevant relationships by Sreelatha Naikno disclosure on file for Dimple Tejwani; SESSION TITLE: COPD Outcomes from the Hospital to Home SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 PM - 2:30 PM PURPOSE: Various mechanisms for hypercapnia (HC) in chronic obstructive pulmonary disease (COPD) have been established. However, characteristics of COPD exacerbation patients, degree of hypercapnia, and the outcomes like mortality and readmissions if determined can improve disposition and improve morbidity of the patients. METHODS: Geisinger Health System admissions between 2016 and 2020 with COPD exacerbation were selected. Inclusion criteria included principal diagnosis of COPD, age >18 years, had arterial blood gas, pulmonary function tests, and received steroids during the hospitalization. Cox regression model and GEE logistic model were used to determine the characteristics including demographics, comorbidities, and odds for outcomes of COPD-HC (pCO2 >52) vs non-HC (pCO2 <52) group. RESULTS: Out of the total 140,947 COPD admissions, 5606 encounters met inclusion, with 2706 unique patients. Of 2706, 59.2 % (n=1603) had 1 encounter and 1.7% (n=45) had 10 or more encounters. We compared characteristics of COPD-HC, defined as PaCO2 >=52 (n (n= 2355) and non-HC defined as PaCO2 < 52(n= 3251). The median age was 66.7 years in the HC group and 68.8 years in the non-HC group (p=0.2355). Both HC and non-HC cohorts were not statistically different by age, gender, race, BMI, alcohol use, drug use, smoking, and tobacco use. HC group more often had heart failure (65% vs 56.3%), OSA (44.2% vs vs33.4%), and less often had CKD (32% vs 42.4%) than the non-HC group (p<0.05). The HC group had higher use of inhalers including LAMA (21.6% vs 17.9%), ICS (56.5% vs 43.4%), and LABA (32.7% v/s 29.9%) than the non-HC group (p<0.05). FEV1/FVC ratio [45 vs 54], actual FEV1 [0.76 vs 1.14], percent FEV1 [30 vs 46], actual FVC [1.68 vs 2.25] and percent FVC [50 vs 66] showed greater obstruction in the HC group than the non-HC group (p <0.0001). HC group had significantly higher odds of mortality inpatient [OR 1.58 (1.05, 2.39)], within 30 days of admission [OR 1.65 (1.31, 2.09)] and discharge [OR 1.65 (1.30, 2.10)], and within 60 days of admission [OR 1.61 (1.31, 1.97)] and discharge [OR 1.48 (1.20,1.82)] (p<0.05). The odds of readmissions within both groups did not show any significant difference. HC admissions had prolonged hospital stay compared to non-HC admissions (5.42 vs 4.45 days, p<0.05). CONCLUSIONS: In our single-center analysis of COPD exacerbations, patients with hypercapnia were more likely to have marked airflow limitation by pulmonary function testing, more likely to have comorbid heart failure and sleep apnea. Hypercapnic patients had higher in-hospital, 30-day, and 60-day mortality, but did not influence readmission rates. CLINICAL IMPLICATIONS: Our study indicates that HC-COPD hospitalizations are likely due to the disease pathology, thus, remedies like Bipap may not be appropriate. Further prospective trials are necessary to understand the disease process and provide just care to COPD patients with hypercapnia. DISCLOSURES: No relevant relationships by Andrea Berger No relevant relationships by Zainab Gandhi No relevant relationships by Sreelatha Naik no disclosure on file for Dimple Tejwani

PARADOXICAL EFFECT OF CANNABIS USE ON COPD EXACERBATIONS: A NATIONWIDE ANALYSIS

SESSION TITLE: COPD Outcomes from the Hospital to HomeSESSION TYPE: Original InvestigationsPRESENTED ON: 10/17/22 1:30 PM - 2:30 PMPURPOSE: The use of cannabis is tremendously rising for medicinal as well as recreational purposes, however, its effects on chronic obstructive pulmonary disease (COPD) remains unexplored. We aimed to assess the odds of acute exacerbation of COPD (AECOPD) in COPD patients hospitalized with and without known cannabis use disorder (CUD).METHODS: We scrutinized the National Inpatient Sample (2018) to identify adult COPD admissions with and without CUD using ICD-10 codes. We compared the baseline characteristics, comorbidities, and in-patient outcomes. Primary outcomes were all-cause mortality and Major Adverse Cardiac and Cerebrovascular Events (MACCE: AMI, Cardiac Arrest and Stroke). Secondary outcomes were the hospital length of stay, patient disposition, and hospital charges. We performed multivariable analyses after adjusting confounders to assess the odds of AECOPD and subsequent cardiovascular complications.RESULTS: Of 80280 COPD admissions with CUD, 7050 were related to AECOPD. The overall prevalence of AECOPD was significantly lower (8.8% vs 16.5%) in the CUD+ cohort including in subgroups by age (18-44, 45-64, ≥65), sex, race. Cannabis use decreased the risk of AECOPD on unadjusted (OR:0.49, 95%CI:0.45-0.53) and adjusted [sociodemographics-(OR:0.79, 95%CI:0.74-0.84), sociodemographics+comorbidities-(OR:0.71, 95%CI:0.67-0.76)] regression analyses (p<0.001). The COPD-CUD+ group often consisted of younger (median 57 vs. 70 years), black (27.4% vs. 11.8%), males (60.7% vs 46.6%) vs. COPD-CUD- group (p<0.001). The COPD-CUD+ group were often admitted non-electively (96.2% vs 95.6%, p=0.01), to urban teaching hospitals (67.6% vs 59.5%, p<0.001), Medicaid enrollees (39.4% vs 11.3%, p<0.001) and belonged to low-income quartile (48.3% vs 35.9%, p<0.001), vs. the COPD-CUD- group. The COPD-CUD+ group had a lower rate of traditional CVD risk factors, however, it was frequently associated with substance abuse, mental health disorders and liver disease (p<0.001) vs. CUD- cohort. On multivariable regression analysis, there was no significant association of CUD with all-cause mortality (OR:0.85, 95%CI:0.58-1.23, p=0.385) and MACCE (OR-1.18, 95%CI-0.97-1.44, p=0.092) in AECOPD admissions. Furthermore. the CUD+ cohort experienced shorter hospital stays (4 vs 5 days) and lower hospital cost ($9649 vs $10424) compared to COPD-CUD- group (p<0.001).CONCLUSIONS: Cannabis use disorder may have a protective effect with a decreased likelihood of acute exacerbations by ~30% in COPD patients, without a significant effect on subsequent all-cause mortality and MACCE.CLINICAL IMPLICATIONS: This study proclaims the need for future prospective studies to explore the association and potential therapeutic use of medicinal cannabis in COPD to decrease exacerbations and effects of recreational use of marijuana on COPD outcomes that frequently lead to hospitalizations and increase healthcare cost.DISCLOSURES: no disclosure submitted for Roshna Asifali;No relevant relationships by roshna AsifaliNo relevant relationships by Bhavana BaraskarNo relevant relationships by Brian BreretonNo relevant relationships by Rupak DesaiNo relevant relationships by Jaspreet KumarNo relevant relationships by Taherunnisa RidaNo relevant relationships by Bisharah RizviNo relevant relationships by Swapnil SurpurNo relevant relationships by Ummul UmmulNo relevant relationships by Siva Naga Yarrarapu SESSION TITLE: COPD Outcomes from the Hospital to Home SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 PM - 2:30 PM PURPOSE: The use of cannabis is tremendously rising for medicinal as well as recreational purposes, however, its effects on chronic obstructive pulmonary disease (COPD) remains unexplored. We aimed to assess the odds of acute exacerbation of COPD (AECOPD) in COPD patients hospitalized with and without known cannabis use disorder (CUD). METHODS: We scrutinized the National Inpatient Sample (2018) to identify adult COPD admissions with and without CUD using ICD-10 codes. We compared the baseline characteristics, comorbidities, and in-patient outcomes. Primary outcomes were all-cause mortality and Major Adverse Cardiac and Cerebrovascular Events (MACCE: AMI, Cardiac Arrest and Stroke). Secondary outcomes were the hospital length of stay, patient disposition, and hospital charges. We performed multivariable analyses after adjusting confounders to assess the odds of AECOPD and subsequent cardiovascular complications. RESULTS: Of 80280 COPD admissions with CUD, 7050 were related to AECOPD. The overall prevalence of AECOPD was significantly lower (8.8% vs 16.5%) in the CUD+ cohort including in subgroups by age (18-44, 45-64, ≥65), sex, race. Cannabis use decreased the risk of AECOPD on unadjusted (OR:0.49, 95%CI:0.45-0.53) and adjusted [sociodemographics-(OR:0.79, 95%CI:0.74-0.84), sociodemographics+comorbidities-(OR:0.71, 95%CI:0.67-0.76)] regression analyses (p<0.001). The COPD-CUD+ group often consisted of younger (median 57 vs. 70 years), black (27.4% vs. 11.8%), males (60.7% vs 46.6%) vs. COPD-CUD- group (p<0.001). The COPD-CUD+ group were often admitted non-electively (96.2% vs 95.6%, p=0.01), to urban teaching hospitals (67.6% vs 59.5%, p<0.001), Medicaid enrollees (39.4% vs 11.3%, p<0.001) and belonged to low-income quartile (48.3% vs 35.9%, p<0.001), vs. the COPD-CUD- group. The COPD-CUD+ group had a lower rate of traditional CVD risk factors, however, it was frequently associated with substance abuse, mental health disorders and liver disease (p<0.001) vs. CUD- cohort. On multivariable regression analysis, there was no significant association of CUD with all-cause mortality (OR:0.85, 95%CI:0.58-1.23, p=0.385) and MACCE (OR-1.18, 95%CI-0.97-1.44, p=0.092) in AECOPD admissions. Furthermore. the CUD+ cohort experienced shorter hospital stays (4 vs 5 days) and lower hospital cost ($9649 vs $10424) compared to COPD-CUD- group (p<0.001). CONCLUSIONS: Cannabis use disorder may have a protective effect with a decreased likelihood of acute exacerbations by ~30% in COPD patients, without a significant effect on subsequent all-cause mortality and MACCE. CLINICAL IMPLICATIONS: This study proclaims the need for future prospective studies to explore the association and potential therapeutic use of medicinal cannabis in COPD to decrease exacerbations and effects of recreational use of marijuana on COPD outcomes that frequently lead to hospitalizations and increase healthcare cost. DISCLOSURES: no disclosure submitted for Roshna Asifali; No relevant relationships by roshna Asifali No relevant relationships by Bhavana Baraskar No relevant relationships by Brian Brereton No relevant relationships by Rupak Desai No relevant relationships by Jaspreet Kumar No relevant relationships by Taherunnisa Rida No relevant relationships by Bisharah Rizvi No relevant relationships by Swapnil Surpur No relevant relationships by Ummul Ummul No relevant relationships by Siva Naga Yarrarapu