Chronic Obstructive Pulmonary Disease Hospitalizations Research Articles

Correlation between disease severity factors and EQ-5D utilities in chronic obstructive pulmonary disease.

Impaired health-related quality of life (HRQoL) is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). The aim of this study was to determine health utilities in patients with COPD and to identify the variables with the greatest impact. This is a pooled analysis of data from 4 observational studies performed in stable COPD patients. Evaluation of patient HRQoL utilities was performed using the Spanish version of the self-administered EuroQoL 5 Dimensions (EQ-5D) questionnaire. EQ-5D utilities were described and compared according to several markers of disease severity. 6198 patients reported a mean (SD) EQ-5D index of 0.67 (0.26). A linear dose response relationship between EQ-5D utility and modified Medical Research Council (mMRC) score, forced expiratory volume in one 1s (% predicted), COPD hospital admissions in the previous year, self-reported daily walking time, Charlson index, body mass index, obstruction, dyspnoea and exacerbation (BODEx) index, COPD assessment test (CAT), hospital anxiety and depression scale was observed (p for trend < 0.001). In multivariate analysis, patients reporting lower utility values were those with more dyspnoea, more comorbidities, using long-term oxygen therapy, with previous hospitalisations due to a COPD exacerbation and higher (worse) CAT score. HRQoL measures such as EQ-5D can assist clinicians to understand the impact of respiratory disease on COPD patients.

Health impact of China Coal Consumption Cap Project

S20: A world less dependent on fossil fuels – scientific evidence and corporate influence. An ISEE Policy Committee Symposium, Room 315, Floor 3, August 26, 2019, 10:30 AM - 12:00 PM Background/Aim: The China Coal Consumption Cap Project (CCCCP) (2013-2020) is one of the most important actions to mitigate air pollution by controlling coal consumption in China. We aimed to take 2013 as a baseline to evaluate the effects of the CCCCP and the related health impacts. Methods: Beijing, Taiyuan, and Guangzhou were selected as typical cities in mainland China. An analysis of the PM2.5 monitoring and morbidity/mortality data was conducted to estimate the health losses caused by coal consumption. Changes in outpatient/emergency room visit, hospitalization and mortality were calculated to assess the health impact of the CCCCP, in 2017 and 2020, respectively. Results: The concentration of PM2.5 in Beijing, Taiyuan, and Guangzhou decreased from 89.50μg/m3 to 58.00μg/m3, 75.02μg/m3 to 59.00μg/m3, and 51.73μg/m3 to 35.00μg/m3, respectively in 2013-2017 (and will drop to 50.00μg/m3, 47.00μg/m3, 30.00μg/m3 in 2020 scenario respectively, numbers in the parenthesis are the 2020 value, the same applies to the following). During this period, Ischemic Heart Disease and Chronic Obstructive Pulmonary Disease hospitalization, and non-accidental deaths in Beijing due to coal burning decreased (will decrease) by 1,990(2,461) and 995(1,205) person-times, and 1099(1,396) cases, respectively. The total number of hospitalizations, outpatients, and non-accidental deaths in Taiyuan due to coal burning decreased (will decrease) by 15,728(25,738) and 4,491(7,735) person-times, and 488(881) cases, respectively. The number of emergency patients with circulation and respiratory system diseases, and non-accidental deaths in Guangzhou caused by coal burning decreased (will decrease) by 158(203) and 277(348) person-times, and 3,159(3,908) cases, respectively. Conclusions: There were large reductions in PM2.5 concentrations during the period of CCCCP. Substantial reductions in morbidity and mortality related to control of ambient air pollution were achieved from 2013 to 2017 in China, and the health benefits will be more obvious in 2020, indicating appreciable effectiveness of controlling coal consumption and improving air quality.

Digital health for COPD care: the current state of play.

Chronic obstructive pulmonary disease (COPD) imposes a huge burden to our healthcare systems and societies. To alleviate the burden, digital health-"the use of digital technologies for health"-has been recognized as a potential solution for improving COPD care at scale. The aim of this review is to provide an overview of digital health interventions in COPD care. We accordingly reviewed recent and emerging evidence on digital transformation approaches for COPD care focusing on (I) self-management, (II) in-hospital care, (III) post-discharge care, (IV) hospital-at-home, (V) ambient environment, and (VI) public health surveillance. The emerging approaches included digital-technology-enabled homecare programs, electronic records, big data analytics, and environment-monitoring applications. The digital health approaches of telemonitoring, telehealth and mHealth support the self-management, post-discharge care, and hospital-at-home strategy, with prospective effects on reducing acute COPD exacerbations and hospitalizations. Electronic records and classification tools have been implemented; and their effectiveness needs to be further evaluated in future studies. Air pollution concentrations in the ambient environment are associated with declined lung functions and increased risks for hospitalization and mortality. In all the digital transformation approaches, clinical evidence on reducing mortality, the ultimate goal of digital health intervention, is often inconsistent or insufficient. Digital health transformation provides great opportunities for clinical innovations and discovery of new intervention strategies. Further research remains needed for achieving reliable improvements in clinical outcomes and cost-benefits in future studies.

The association between power outage and the exacerbation of Chronic Obstructive Pulmonary Disease (COPD)

TPS 661: Climate change: temperature effects 1, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: More frequent and severe power outages (PO) are expected as potential results of climate change and increased weather extremes. Significant gaps remain in understanding the potential impact of PO on Chronic Obstructive Pulmonary Disease (COPD) hospitalizations. We examined the association between PO and COPD, as well as its variation across COPD subtypes, lag days, critical care indicators and socio-demographics. Methods: We matched the 2001-2013 daily PO data with the COPD hospitalization numbers at the New York power operating division-level. Using distributed lag nonlinear models controlling for weather and time-varying factors, we compared the number of hospitalizations during PO versus non-PO periods to determine the association of PO with COPD and its subtypes at each of 0-6 lag days, and stratified the results by socio-demographics. We also compared differences in critical care indicators including average length of stay, cost and average number of comorbidities between two periods. Results: Overall, we observed the relative risk (RR) of COPD ranged from 1.14 to 1.43 across lag days. The risk was strongest at lag 0 and lasted significantly for 6 days. Associations were stronger for acute bronchitis (RR: 1.33 to 1.63) and obstructive chronic bronchitis (RR: 1.10 to 1.47). PO impacts were significantly higher when PO coverage exceeded the 75th percentile or lasted longer than 5 days. No significant variations were observed across socio-demographics. Compared with the non-PO period, the PO period was observed to have 0.017 more COPD cases/day, $5367 increase in cost/case and 1.44 more comorbidities/case. Patients with hospital stays costing more than $30000 or having over 9 comorbidities increased to a greater extent during PO relative to other patients. Conclusion: PO was significantly associated with elevated risk of COPD as well as increased cost and comorbidities. Patients at the highest-cost and most-comorbidity groups had the highest increase among all hospitalizations.

Smoke-Free Policies and 30-Day Readmission Rates for Chronic Obstructive Pulmonary Disease

Previous evidence has shown that smoke-free policies reduce hospital admissions due to respiratory causes, but the impact on 30-day readmission has not been determined. As 25 states in the U.S. have not adopted comprehensive smoke-free legislation, it is likely that patients return to an environment that increases risk of a secondary event. The aim of this study is to investigate the impact of smoke-free policies on 30-day readmission rates for adults aged ≥65 years following hospitalization for chronic obstructive pulmonary disease in the U.S. Data from the U.S. Tobacco Control Laws Database, Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program, American Hospital Association, Area Health Resource File, and U.S. Census Bureau Current Population Survey were merged at the county level for years 2013-2016 and analyzed in 2018. Hierarchical Poisson regression models were utilized to calculate incidence rate ratios to determine the impact of full, partial, and no smoke-free policies on 30-day readmission rates after chronic obstructive pulmonary disease hospitalization. Multivariable analysis adjusting for both county and hospital characteristics revealed that the presence of full (incidence rate ratio=0.81, 95% CI=0.76, 0.88) and partial (incidence rate ratio=0.87, 95% CI=0.81, 0.92) smoke-free policies were associated with fewer 30-day readmissions for chronic obstructive pulmonary disease-related hospitalizations when compared with counties with no smoke-free policy. The implementation of smoke-free policies is an effective measure for reducing 30-day readmissions following hospitalization due to chronic obstructive pulmonary disease, with stronger policies resulting in decreased risk. Efforts to reduce chronic obstructive pulmonary disease-related 30-day readmissions should include the implementation of smoke-free policies.

Temporal Trends Of Pharmacologic Therapies For Patients With Chronic Obstructive Pulmonary Disease In Alberta, Canada.

ObjectivesTo describe the trends in pharmacologic treatment for patients newly diagnosed with chronic obstructive pulmonary disease (COPD) in Alberta, Canada.MethodsWe linked Alberta health databases to identify patients aged ≥35 years with incident COPD between April 2010 and March 2017. Incident cases were defined as those who did not have a hospitalization or outpatient visit with COPD in the previous 2 years. Patients were categorized into two groups: 1) incident cases at a hospital and 2) incident cases at an outpatient clinic, and both were followed until death or being censored by 31 March 2018. Utilization of COPD medication for 30 days following incident event and adherence in maintenance therapy over time were reported.ResultsThe study included 33,169 patients with incident COPD (hospital: 9,089; outpatient: 24,080). In 18,666 (56.3%) patients starting medication within 30 days of the incident event (2010: 52.7%; 2016: 56.6%; p=0.002), SABA (60.5%) and LABA/ICS (41.6%) were most commonly used. ICS (without LABA) was used in 14.2% and was used as monotherapy in 4.5% of patients. The proportion of patients who initiated any ICS was similar (hospital: 56.7%; outpatient: 55.7%; p=0.194) and decreased in both settings over time (p<0.001). Drug adherence during the first year after the incident event was 54.3%, higher among hospital patients (66.5% vs 48.9%; p<0.001), and improved over time (2010: 53.4%; 2016: 57.4%; p<0.001).ConclusionThe initiation of and adherence to pharmacologic therapy for patients with COPD is low but improves over time. While SABA and LABA/ICS are most commonly used, ICS utilization decreases over time.

Discriminative Accuracy of FEV1:FVC Thresholds for COPD-Related Hospitalization and Mortality

According to numerous current guidelines, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1:FVC) of less than 0.70, yet this fixed threshold is based on expert opinion and remains controversial. To determine the discriminative accuracy of various FEV1:FVC fixed thresholds for predicting COPD-related hospitalization and mortality. The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 4 US general population-based cohorts (Atherosclerosis Risk in Communities Study; Cardiovascular Health Study; Health, Aging, and Body Composition Study; and Multi-Ethnic Study of Atherosclerosis). Participants aged 45 to 102 years were enrolled from 1987 to 2000 and received follow-up longitudinally through 2016. Presence of airflow obstruction, which was defined by a baseline FEV1:FVC less than a range of fixed thresholds (0.75 to 0.65) or less than the lower limit of normal as defined by Global Lung Initiative reference equations (LLN). The primary outcome was a composite of COPD hospitalization and COPD-related mortality, defined by adjudication or administrative criteria. The optimal fixed FEV1:FVC threshold was defined by the best discrimination for these COPD-related events as indexed using the Harrell C statistic from unadjusted Cox proportional hazards models. Differences in C statistics were compared with respect to less than 0.70 and less than LLN thresholds using a nonparametric approach. Among 24 207 adults in the pooled cohort (mean [SD] age at enrollment, 63 [10.5] years; 12 990 [54%] women; 16 794 [69%] non-Hispanic white; 15 181 [63%] ever smokers), complete follow-up was available for 11 077 (77%) at 15 years. During a median follow-up of 15 years, 3925 participants experienced COPD-related events over 340 757 person-years of follow-up (incidence density rate, 11.5 per 1000 person-years), including 3563 COPD-related hospitalizations and 447 COPD-related deaths. With respect to discrimination of COPD-related events, the optimal fixed threshold (0.71; C statistic for optimal fixed threshold, 0.696) was not significantly different from the 0.70 threshold (difference, 0.001 [95% CI, -0.002 to 0.004]) but was more accurate than the LLN threshold (difference, 0.034 [95% CI, 0.028 to 0.041]). The 0.70 threshold provided optimal discrimination in the subgroup analysis of ever smokers and in adjusted models. Defining airflow obstruction as FEV1:FVC less than 0.70 provided discrimination of COPD-related hospitalization and mortality that was not significantly different or was more accurate than other fixed thresholds and the LLN. These results support the use of FEV1:FVC less than 0.70 to identify individuals at risk of clinically significant COPD.

Socioeconomic status (SES) and 30-day hospital readmissions for chronic obstructive pulmonary (COPD) disease: A population-based cohort study

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are more likely to be readmitted than patients with other chronic medical conditions, yet knowledge regarding such readmissions is limited. We aimed to determine factors associated with readmission within 30 days of a COPD hospitalization or death with an emphasis on examining aspects of socioeconomic status and specific comorbidities.MethodsA population-based cohort study was conducted using health administrative data from Ontario, Canada. All hospitalizations for COPD between 2004 and 2014 were considered. The primary exposures were socioeconomic status as measured by residential instability (an ecologic variable), and comorbidities such as cardiovascular disease and cancer. Other domains of socioeconomic status were considered as secondary exposures. Logistic regression with generalized estimating equations was used to examine the effect of exposures, adjusting for other patient factors, on 30-day readmission or death.ResultsThere were 126,013 patients contributing to 252,756 index COPD hospitalizations from 168 Ontario hospitals. Of these hospitalizations, 19.4% resulted in a readmission and 2.8% resulted in death within 30 days. After adjusting for other factors, readmissions or death were modestly more likely among people with the highest residential instability compared to the lowest (OR 1.05, 95% CI 1.01–1.09). Comorbidities such as cardiovascular disease and cancer, as well as other aspects of low socioeconomic status also increased readmission or death risk.InterpretationSocioeconomic status, measured in various ways, and many comorbidities predict 30-day readmission or death in patients hospitalized for COPD. Strategies that address these factors may help reduce readmissions and death.

Sputum Microbiome Is Associated with 1-Year Mortality after Chronic Obstructive Pulmonary Disease Hospitalizations.

Rationale: Lung dysbiosis promotes airway inflammation and decreased local immunity, potentially playing a role in the pathogenesis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Objectives: We sought to determine the relationship between sputum microbiome at the time of AECOPD hospitalization and 1-year mortality in a COPD cohort. Methods: We used sputum samples from 102 patients hospitalized because of AECOPD. All subjects were followed for 1 year after discharge. The microbiome profile was assessed through sequencing of 16S rRNA gene. Microbiome analyses were performed according to 1-year mortality status. To investigate the effect of α-diversity measures and taxon features on time to death, we applied Cox proportional hazards regression models and obtained hazard ratios (HRs) associated with these variables. Measurements and Main Results: We observed significantly lower values of α-diversity (richness, Shannon index, evenness, and Faith's Phylogenetic Diversity) among nonsurvivors (n = 19, 18.6%) than survivors (n = 83, 81.4%). β-Diversity analysis also demonstrated significant differences between both groups (adjusted permutational multivariate ANOVA, P = 0.010). The survivors had a higher relative abundance of Veillonella; in contrast, nonsurvivors had a higher abundance of Staphylococcus. The adjusted HRs for 1-year mortality increased significantly with decreasing α-diversity. We also observed lower survival among patients in whom sputum samples were negative for Veillonella (HR, 13.5; 95% confidence interval, 4.2-43.9; P < 0.001) or positive for Staphylococcus (HR, 7.3; 95% confidence interval, 1.6-33.2; P = 0.01). Conclusions: The microbiome profile of sputum in AECOPD is associated with 1-year mortality and may be used to identify subjects with a poor prognosis at the time of hospitalization.

Development and first validation of a patient-reported experience measure in chronic obstructive pulmonary disease (PREM-C9)

We developed a chronic obstructive pulmonary disease (COPD) patient-reported experience measure (PREM-C9). 174 patients with COPD (86 [49%] with a confirmed diagnosis and 88 [51%] with a self-reported diagnosis of...

Changes in the acute response of respiratory diseases to PM2.5 in New York State from 2005 to 2016

Prior studies reported that exposure to increased concentrations of fine particulate matter (PM2.5) were associated with increased rates of hospitalization and emergency department (ED) visits for asthma and chronic obstructive pulmonary disease (COPD). In this study, rates were examined from 2005 to 2016 using a case-crossover design to ascertain if there have been changes in the rates per unit mass exposure given substantial reductions in PM2.5 concentration and changes in its composition. PM2.5 concentrations were reduced through a combination of policies designed to improve air quality and economic drivers, including the 2008 economic recession and shifts in the relative costs of coal and natural gas. The study period was split into three periods reflecting that much of the emissions changes occurred between 2008 and 2013. Thus, the three periods were defined as: BEFORE (2005 to 2007), DURING (2008–2013), and AFTER (2014–2016). In general, the number of hospitalizations and ED visits declined with the decreased concentration of PM2.5. However, the rate of COPD hospitalizations and asthma ED visits associated with each interquartile range increase in ambient PM2.5 concentration was larger in the AFTER period than the DURING and BEFORE periods. For example, each 6.8 μg/m3 increase in PM2.5 on the same day was associated with 0.4% (0.0%, 0.8%), 0.3% (−0.2%, 0.7%), and 2.7% (1.9%, 3.5) increases in the rate of asthma emergency department visits in the BEFORE, DURING, and AFTER periods, respectively, suggesting the same mass concentration of PM2.5 was more toxic in the AFTER period.

Metformin use mitigates the adverse prognostic effect of diabetes mellitus in chronic obstructive pulmonary disease

Background and objectiveAmong patients with chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) is a common comorbidity and is probably associated with increased systemic inflammation and worse prognosis. Metformin, with its pleiotropic anti-inflammatory and antioxidant actions, may offer theoretical benefits in COPD patients with DM. Thus, this study aimed to investigate the effects of DM and metformin use on mortality in the clinical trajectory of COPD.MethodsThis was a retrospective cohort study comprising patients with spirometry-confirmed COPD and an age of ≥40 years from 2008 to 2014. The primary outcome of interest was all-cause mortality. We evaluated the effects of DM on mortality through the clinical course of COPD and we also assessed the impact of metformin use on survival of the COPD population.ResultsAmong 4231 COPD patients, 556 (13%) had DM, and these patients had 1.62 times higher hazards of 2-year mortality than those without DM (95% confidence interval [CI], 1.15–2.28) after adjusting for age, gender, COPD stage, comorbidities and prior COPD hospitalization. Over a 2-year period, metformin users had a significantly lower risk of death (hazard ratio, 0.46; 95% CI, 0.23–0.92) compared with non-metformin users in patients with coexistent COPD and DM. Moreover, metformin users had similar survival to COPD patients without DM.ConclusionsThis study shows that DM is associated with an increased risk of death in COPD patients and metformin use seems to mitigate the hazard. Our findings suggest a potential role of metformin in the management of DM in COPD.

A Systematic Review and Meta-Analysis on Short-Term Particulate Matter Exposure and Chronic Obstructive Pulmonary Disease Hospitalizations in China.

We conducted a meta-analysis of short-term particulate matter (PM) exposure and chronic obstructive pulmonary disease (COPD) hospitalizations in China, including data from two-pollutant model. From PubMed and Web of Science, we selected case-crossover or time-series studies conducted in Mainland China, Hong Kong, Macao, or Taiwan to investigate the association between PM exposure and COPD hospitalizations. The meta-analysis was performed using data from both single-pollutant and two-pollutant models for PM2.5 and PM10. A total of 16 studies were included in our analysis. Short-term exposure to PM2.5 and PM10 were both significantly associated with COPD hospitalizations. The results remained robust in two-pollutant model, whereas subgroup analyses demonstrated a modest heterogeneity. Our review shows a small but obvious exposure-hospitalization effect in China. More studies are needed to generate the needed evidence, and advocacy is needed to stimulate initiation of solutions to the problem.

Efficacy and safety profile of roflumilast in a real-world experience.

Roflumilast is the only phosphodiesterase enzyme 4 inhibitor approved in the treatment of chronic obstructive pulmonary disease (COPD) patients with chronic cough and sputum and a history of exacerbations. Real-world studies about the use of roflumilast are limited. Our aim was to assess the efficacy, safety and tolerability of roflumilast in the treatment of stable COPD, in a real-world setting. From August 2014 to August 2017, medical records of all COPD patients who were prescribed roflumilast therapy in Akdeniz University Hospital were analyzed retrospectively. COPD patients were studied in terms of efficacy, safety, and drug discontinuation rate. Efficacy was evaluated as the effect of roflumilast on exacerbation and hospitalization rates of COPD compared to the pre-treatment period. Eighty-three COPD patients treated with roflumilast were included (mean age 66.2±9.3 years, 88.0% male). All the patients were chronic bronchitis and frequent exacerbator clinical phenotype and were classified in the Global Initiative for Chronic Obstructive Lung Disease categories C (n=17; 20.5%) and D (n=66; 79.5%). Mean duration of roflumilast use was 18.9±10.4 months. There was a significant decrease in both COPD exacerbations (2.7 vs. 1.16; P<0.001) and hospitalizations (0.77 vs. 0.32; P<0.001) in roflumilast users compared to the pre-treatment period. Of the patients, 22 (26.5%) experienced adverse events (AE) during their treatment period. The most frequently reported AEs were weight loss (10.8%), loss of appetite (10.8%) and nausea (8.4%). Serious or life-threatening AEs were not detected. Sixteen (19.3%) patients discontinued roflumilast because of AEs. Roflumilast reduced exacerbations and hospitalizations in our real-world population with severe COPD. AEs are common and frequently leading to discontinuation of roflumilast therapy.

Factors contributing to COPD hospitalisations from 2010 to 2015: Variation among rural and metropolitan Australians.

Rural and remote populations experience the greatest burden of chronic obstructive pulmonary disease (COPD), the fifth leading cause of death in Australia. Currently there is a need to prioritise health services to improve health outcomes among those at higher risk of COPD. To investigate the differences in COPD hospitalisation between rural and urban populations and determine predictive factors contributing to COPD hospitalisation. Statewide hospitalisation data from 2010 to 2015 were obtained through the Victorian Admitted Episodes Dataset and other key data sets. The rates of hospitalisation were analysed using hierarchical multiple regression to examine the association between COPD hospitalisations and a number of predictor variables. The highest COPD incidence occurred in metropolitan males aged 85years of age and older (35.092 hospitalisations per 1000 population). Among metropolitan residents, smoking, population density and household income had a significant association with COPD hospitalisations for both sexes. Among rural males, smoking rates, household income and rural land use (farming) were significant predictors of COPD hospitalisations. There was an overall stability in statewide COPD hospitalisation over the 5 years to 2015, P=0.420. This investigation highlights many rural and regional areas have much lower COPD hospitalisation rates than metropolitan areas. Between males and females, there are heterogenetic factors that contribute to the significant variation associated with COPD hospitalisation in metropolitan and rural areas, such as rural land use among rural males. This indicates that risk factor assessments, beyond smoking alone, need to be individualised and prioritised in practice to optimise care.

Gender differences in chronic obstructive pulmonary disease: an analysis of hospitalization indicators

Compared to the last two decades, an increase in chronic obstructive pulmonary disease (COPD) prevalence, morbidity, mortality and disability has clearly emerged among women both in Europe and in all other countries. Despite this evidence, in the international guidelines for COPD there are no sex-specific recommendations. The aim of this study is to evaluate gender differences in patients hospitalized for COPD in Puglia (Italy), with regard to number of admissions, mean age, average length of stay in hospital (ALOS), hospital mortality, re-hospitalization and presence of comorbidities. To identify COPD hospitalized patients, we relied on the Puglia Hospital Discharge Register Database. We included all patients discharged with principal diagnosis of COPD with or without exacerbation (respectively ICD-9-CM codes 491.21 and 491.20) between 2005 and 2016. There has been an increase in the proportion of women’s hospitalizations for COPD, from 2005 [31.9%, 95% confidence interval (CI) 31.1-32.7] to 2016 (37.9%, 95%CI 36.0-40.0). Women need longer hospitalization and in 2016 the proportion of women’s re-hospitalization was greater compared to men. Despite these data, women are less treated with respiratory therapy (ICD-9- CM 93.9x) than men in all the examined years and wards. The prevalence of most common comorbidities is higher among women. The number of COPD hospitalized patients had been reduced in Puglia between 2005 and 2016, with an important increase of female COPD patients, female average age, ALOS and re-hospitalization. Women are treated less and have more comorbidities with a negative impact on clinical progression of COPD, survival and quality of life.

Increased susceptibility to heat for respiratory hospitalizations in Hong Kong

BackgroundEmerging studies have shown temperature-mortality association is changing over time, but little is known about the temporal changes of the temperature-morbidity association. ObjectivesWe aimed to evaluate the temporal variations in both temperature-respiratory hospitalizations associations and temperature-related attributable risks in Hong Kong. MethodsWe collected 17-year time-series data on daily ambient temperature and emergency hospital admissions for respiratory diseases between 2000 and 2016 in Hong Kong. Quasi-Poisson regression with a time-varying distributed lag nonlinear model was used to estimate the year-specific association between temperature and respiratory hospitalizations [total respiratory, pneumonia, and chronic obstructive pulmonary disease (COPD)] and the year-specific attributable fraction (AF) for heat and cold (defined as above/below the optimum temperature, respectively). ResultsHeat-related risks and AFs increased continuously for total respiratory, pneumonia and COPD hospitalizations during the past 17 years, respectively. Cold-hospitalization associations and cold-related AFs showed heterogeneous patterns, showing a decreasing trend for pneumonia but a general increasing trend for COPD for both the associations and AFs. The total temperature-related AFs remained stable for total respiratory (p for trend = 0.136) and pneumonia (p for trend = 0.406), but showed an increasing trend for COPD (p for trend < 0.001) from 10% (95% empirical CI: 2%, 17%) in 2000 to 17% (95% empirical CI: 11%, 22%) in 2016. ConclusionsOur findings indicate an increased susceptibility to heat but a decreased susceptibility to cold for respiratory hospitalizations during the past 17 years. The overall temperature-related hospitalization burden for respiratory diseases was generally stable in Hong Kong.

Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic Society Workshop Report.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of hospital readmissions in the United States. The quality of care delivered to patients with COPD is known to be lacking across the care continuum, and may contribute to high rates of readmission. As part of the response to these issues, the Centers for Medicare and Medicaid instituted a penalty for 30-day readmissions as part of their Hospital Readmission Reduction Program in October 2014. At the time the penalty was instated, there was little published evidence on effective hospital-based programs to reduce readmissions after acute exacerbations of COPD. Even now, several years later, few published programs exist, and we continue to lack consistent approaches that lead to improved readmission rates. In addition, there was concern that the penalty would widen health disparities. Despite the dearth of published evidence to reduce readmissions beyond available COPD guidelines, many hospitals across the United States began to develop and implement programs, based on little evidence, due to the financial penalty. We, therefore, assembled a diverse group of clinicians, researchers, payers, and program leaders from across the country to present and discuss approaches that had the greatest potential for success. We drew on expertise from ongoing readmission reduction programs, implementation methodologies, and stakeholder perspectives to develop this Workshop Report on current best practices and models for addressing COPD hospital readmissions.

The burden and impact of arrhythmia in chronic obstructive pulmonary disease: Insights from the National Inpatient Sample

BackgroundWe aimed to analyze the burden and predictors of arrhythmias and in-hospital mortality in chronic obstructive pulmonary disease (COPD)-related hospitalizations using the nationwide cohort. MethodsWe queried the National Inpatient Sample (NIS) (2010–2014) databases to identify adult COPD hospitalizations with arrhythmia. Categorical and continuous variables were compared using Chi-square and Student's t-test/ANOVA. Predictors of any arrhythmia including AF and in-hospital mortality were evaluated by multivariable analyses. ResultsOut of 21,596,342 COPD hospitalizations, 6,480,799 (30%) revealed co-existent arrhythmias including 4,767,401 AF-arrhythmias (22.1%) and 1,713,398 non AF-arrhythmias (7.9%). The AF or non-AF arrhythmia cohort consisted mostly of older (mean age~ 75.8 & 69.1 vs. 67.5 years) white male (53.3% & 51.9% vs. 46.9%) patients compared to those without arrhythmias (p < 0.001). The all-cause mortality (5.7% & 5.2 vs. 2.9%), mean length of stay (LOS) (6.4 & 6.5 vs. 5.3 days), and hospital charges ($52,699.49 & $58,102.39 vs. $41,208.02) were higher with AF and non AF-arrhythmia compared to the non-arrhythmia group (p < 0.001). Comorbidities such as cardiomyopathy (OR 2.11), cardiogenic shock (OR 1.88), valvular diseases (OR 1.60), congestive heart failure (OR 1.48) and pulmonary circulation disorders (OR 1.25) predicted in-hospital arrhythmias. Invasive mechanical ventilation (OR 6.41), cardiogenic shock (OR 5.95), cerebrovascular disease (OR 3.95), septicemia (OR 2.30) and acute myocardial infarction (OR 2.24) predicted higher mortality (p < 0.001) in the COPD-arrhythmia cohort. ConclusionsAbout 30% of COPD hospitalizations revealed co-existent arrhythmias (AF 22.1%). All-cause mortality, LOS and hospital charges were significantly higher with arrhythmias. We observed racial and sex-based disparities for arrhythmias and related mortality.

Endobronchial coils in treatment of advanced emphysema: A single center experience.

This study aims to present our experience with endobronchial coils in patients who underwent endobronchial lung volume reduction due to advanced emphysema. The study included 46 patients (45 males, 1 female; mean age 61.7±8 years; range, 43 to 80 years) who underwent endobronchial lung volume reduction with endobronchial coils for advanced emphysema. Patients" age, gender, pulmonary function tests, post-treatment morbidity, mortality, pre- and post-treatment (6 months) six-minute walking distance, modified Medical Research Council dyspnea scores, chronic obstructive pulmonary disease assessment test and Hospital Anxiety and Depression Scale scores were recorded. Patients had an average of 65 pack/year smoking history. An average of 11 (range, 9-15) coils were placed per lobe (right upper lobe=35, left upper lobe=19, right lower lobe=2, left lower lobe=4). Mean follow-up duration was 12.6 months (±5.6 months). Post-treatment forced expiratory volume in one second, residual volume and six-minute walking distance values were improved with statistical significance. Also, significant improvement was seen in quality of life, quantified by modified Medical Research Council, chronic obstructive pulmonary disease assessment test and Hospital Anxiety and Depression Scale scores. While no immediate major postoperative complications occurred, three patients developed chronic obstructive pulmonary disease exacerbation, two developed pneumonia, and one developed recurrence of previous neurologic disorder within 30 days. Endobronchial coil administration provides lower morbidity and mortality compared to lung volume reduction surgery as well as significant improvement in pulmonary functions and quality of life in selected patients with advanced emphysema.