COPD Hospital Admission Research Articles

The effect of air pollutants on COPD-hospitalized patients in Lanzhou, China (2015-2019).

Lanzhou is the largest heavy industrial city in northwest China and it is a typical geographical valley-like city. However, there are few studies on the relationship between air pollutants and COPD, and their respective sample sizes are small, resulting in inconsistent results. The aim of this study is to analyze the effects of air pollutants on COPD hospitalizations in Lanzhou, China. An ecological time series study with distributed lag non-linear model (DLNM) was used for analysis. Daily COPD hospitalization data in Lanzhou from 1 January 2015 to 31 December 2019 were collected from 25 hospitals, as well as air pollutant data and meteorological data. A total of 18,275 COPD hospitalizations were enrolled. For 10 μg/m3 increase in PM2.5, PM10, SO2, NO2, and 1 mg/m3 increase in CO at lag 07 day, the RR95%CI of COPD hospitalizations were 1.048 (1.030, 1.067), 1.008 (1.004, 1.013), 1.091 (1.048, 1.135), 1.043 (1.018, 1.068), and 1.160 (1.084, 1.242), respectively. The exposure-response curves between air pollutants (except O3-8h) and COPD hospitalizations were approximately linear with no thresholds. Female, and the harmful effect of PM on aged <65 years, the effect of gaseous pollutant on those aged ≥65 years, were stronger, particularly in the cold season. Exposure to air pollutants (except O3-8h) might increase the risk of COPD hospitalizations. O3-8h has a weak and unstable effect on COPD. Exposure to air pollutants (except O3-8h) increases the risk of COPD hospitalizations. O3-8h has a weak and unstable effect on COPD hospital admissions. The harmful effect of gaseous pollutants (except O3-8h) on COPD-hospitalized patients was stronger than that of PM.

Temporal characteristics and health effects related to NO2, O3, and SO2 in an urban area of Iran

This study reports on temporal variations of NO2, O3, and SO2 pollutants and their related health effects in urban air of Khorramabad, Iran using AirQ 2.2.3 software. Based on data between 2015 and 2021, hourly NO2, O3, and SO2 concentrations increase starting at 6:00 a.m. local time until 9:00 p.m., 3:00 p.m., and 7:00 p.m. local time, respectively, before gradually decreasing. The highest monthly NO2, O3, and SO2 concentrations are observed in October, August, and September, respectively. Annual median NO2, O3, and SO2 concentrations range between 17 ppb and 38.8 ppb, 17.5 ppb–36.6 ppb, and ∼14 ppb–30.8 ppb, respectively. Two to 93 days and 17–156 days between 2015 and 2021 exhibit daily concentrations of NO2 and SO2 ≤ WHO AQGs, respectively, while 187–294 days have 8-h maximum O3 concentrations ≤ WHO AQGs. The mean excess mortality ascribed to respiratory mortality, cardiovascular mortality, hospital admissions for COPD, and acute myocardial infraction are 121, 603, 39, and 145 during 2015–2021, respectively. O3 is found to exert more significant health effects compared to SO2 and NO2, resulting in higher cardiovascular mortality. The gradual increase in NO2 and possibly O3 over the study period is suspected to be due to economic sanctions, while SO2 decreased due to regulatory activity. Sustainable control strategies such as improving fuel quality, promoting public transportation and vehicle retirement, applying subsidies for purchase of electric vehicles, and application of European emission standards on automobiles can help decrease target pollutant levels in ambient air of cities in developing countries.

Spatial distribution of unscheduled hospital admissions for chronic obstructive pulmonary disease in the central area of Asturias, Spain

BackgroundChronic obstructive pulmonary disease (COPD) is one of the major causes of mortality worldwide and also reports high morbidity rates and the global burden COPD has continued to rise over the last several decades. The best-known COPD risk factors are tobacco smoke and air pollution, but genetics, age, sex, and socioeconomic status are additional factors. This study aimed to assess the spatial distribution of unscheduled COPD hospital admissions of men and women in the central area of Asturias during 2016–2018 and identify trends, spatial patterns, or clusters in the area.MethodsUnscheduled COPD hospital admissions in the central area of Asturias were registered, geocoded, and grouped by census tracts (CTs), age, and sex. Standardized admission ratio, smoothed relative risk, posterior risk probability, and spatial clusters between relative risks throughout the study area were calculated and mapped.ResultsThe spatial distribution of COPD hospital admissions differed between men and women. For men, high-risk values were located primarily in the northwestern area of the study, whereas for women the cluster pattern was not as clear and high-risk CTs also reached central and southern areas. In both men and women, the north-northwest area included the majority of CTs with high-risk values.ConclusionsThe present study showed the existence of a spatial distribution pattern of unscheduled COPD hospital admissions in the central area of Asturias that was more pronounced for men than for women. This study could provide a starting point for generating knowledge about COPD epidemiology in Asturias.

Associations of serum sclerostin levels with body composition, pulmonary function, and exacerbations in COPD patients

BackgroundIn COPD, the bronchial epithelium shows a pathologically activated Wnt pathway. Sclerostin (SOST) is a secreted glycoprotein that is associated with bone metabolism and blocks the Wnt pathway. We hypothesized that low sclerostin levels might be associated with lung function and COPD exacerbations in patients. MethodsWe studied 139 outpatients with stable COPD and normal kidney function. We assessed the serum levels of SOST and bone metabolism parameters, body composition, clinical characteristics and lung function at baseline. We followed the patients prospectively for 12 months after enrolment. Moderate exacerbations and hospital admissions were recorded during follow-up. ResultsThe serum SOST levels were 23.98±7.6 pmol/l (men: 25.5±7.7 pmol/l, women: 20.3±5.9 pmol/l (p < 0.001)). SOST showed correlations with age (r = 0.36), FFMI (r = 0.38), FEV1 (r = 0.27), DLCO (r = 0.39), 6MWD (r = 0.19) and CAT (r = -0.24). In multivariate linear regression analysis, only age (beta=0.264) and FFMI (beta=1.241) remained significant. SOST showed a significant negative correlation with serum phosphorus (r = -0.29). Cox proportional risk analysis indicated that patients in the lower tertile of SOST levels were at higher risk of moderate COPD exacerbation (HR 2.015, CI95% 1.136–3.577, p = 0.017) and hospital admission due to COPD (HR 5.142, CI95% 1.380–19.158, p = 0.015) than the rest of the patients. ConclusionsSOST levels are associated with body composition and lung function in patients with COPD. Furthermore, lower SOST levels predict a higher risk of exacerbations and hospitalization.

To assess community care services effectiveness: the use of the Chronic Obstructive Pulmonary Disease in-patient admission rate

Background&#x0D; Assessment of appropriateness is a criteria of increasing relevance for delivering health care services. In Italy elderly hospital admissions for Chronic Obstructive Pulmonary (COPD) disease is one of the chosen indicators to measure the appropriate use of services. This study describes the characteristics of hospital admissions at a regional level for COPD – DRG 88 and to evaluates their relationship with other indicators linked to the provision of hospital or community care services.&#x0D; Methods&#x0D; Data on hospital admissions for COPD in the years 2006 and 2011 were collected from hospital discharge records. Correlations among acute in-patients admission rates by Italy’s Regions and provision of Long Term Care (LTC) services have been analyzed through univariate and multivariate linear regression models.&#x0D; Results&#x0D; The national rate of hospitalization for COPD decreased from 2006 to 2011 (-35%). The COPD in-patient admission rate showed a weak inverse relation with the provision of LTC that was statistically significant only for 65-74 age-group in 2006. The reduction was greater than 60% for those under the age of 75 and around 14% for those over 74 years.&#x0D; The inclusion in the interpretative model the rate of beds per capita in and the rate of General Practitioners improves the percentage of variability between the regions in the rate of hospitalization for the DRG 88 explained by the model itself.&#x0D; Conclusion&#x0D; The reduction in hospitalizations for COPD in the over-fifty age group is particularly noticeable; it seems mainly related to factors other than to the operation of those services outside the hospital.

Investigating the impact of air pollution on AMI and COPD hospital admissions in the coastal city of Qingdao, China

Investigating the impact of air pollution on AMI and COPD hospital admissions in the coastal city of Qingdao, China

Ambient PM2.5 and PM10 Exposure and Respiratory Disease Hospitalization in Kandy, Sri Lanka.

Evidence of associations between exposure to ambient air pollution and health outcomes are sparse in the South Asian region due to limited air pollution exposure and quality health data. This study investigated the potential impacts of ambient particulate matter (PM) on respiratory disease hospitalization in Kandy, Sri Lanka for the year 2019. The Generalized Additive Model (GAM) was applied to estimate the short-term effect of ambient PM on respiratory disease hospitalization. As the second analysis, respiratory disease hospitalizations during two distinct air pollution periods were analyzed. Each 10 μg/m3 increase in same-day exposure to PM2.5 and PM10 was associated with an increased risk of respiratory disease hospitalization by 1.95% (0.25, 3.67) and 1.63% (0.16, 3.12), respectively. The effect of PM2.5 or PM10 on asthma hospitalizations were 4.67% (1.23, 8.23) and 4.04% (1.06, 7.11), respectively (p < 0.05). The 65+ years age group had a higher risk associated with PM2.5 and PM10 exposure and hospital admissions for all respiratory diseases on the same day (2.74% and 2.28%, respectively). Compared to the lower ambient air pollution period, higher increased hospital admissions were observed among those aged above 65 years, males, and COPD and pneumonia hospital admissions during the high ambient air pollution period. Active efforts are crucial to improve ambient air quality in this region to reduce the health effects.

Relationship between Air Pollution and Hospital Admissions for Chronic Obstructive Pulmonary Disease in Changchun, China: A Season-Stratified Case-Cross Study.

Background This study aimed to explore the relationship between air pollution and hospital admissions for COPD in Changchun, a northeast city of China, in different seasons. Methods The data on a total of 1,733 hospitalized patients living in Changchun with acute exacerbation of COPD from September 2013 to April 2018 were collected from a comprehensive 3A hospital of Changchun. Daily average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3 were collected from the Department of Ecology and Environment of Jilin Province. The conditional logistic regression model was adopted to analyze the effect of air pollutant concentration on the number of hospitalized patients with COPD in different seasons. Results The maximum OR value for most air pollutants emitted in spring was on lag day 4, in summer and autumn on lag day 3, and in winter on lag day 2. In spring, SO2 and NO2 were entered into the regression equation, and the OR (95%CI) was 0.992 (0.986–0.998) and 1.009 (1.002–1.017); in autumn, PM2.5, PM10, and SO2 were entered into the regression equation, and the OR (95%CI) was 1.005 (1.000–1.011), 0.995 (0.991–1.000), and 1.006 (1.001–1.011), respectively; and in winter, PM2.5 and PM10 were entered into the regression equation, and the OR (95%CI) was 1.008 (1.002–1.015) and 0.994 (0.988–0.999), respectively. Conclusion The relationship between air pollution and hospital admission for COPD in Northeast China varies with different seasons. In spring, NO2 is likely to be the major risk factor for hospital admissions for COPD; in autumn, PM2.5 and SO2 are the major risk factors; and in winter, PM2.5 is the major risk factor.

Qualitative coronary artery calcification scores and risk of all cause, COPD and pneumonia hospital admission in a large CT lung cancer screening cohort

BackgroundPatients at high-risk for lung cancer and qualified for CT lung cancer screening (CTLS) are at risk for numerous cardio-pulmonary comorbidities. We sought to examine if qualitatively assessed coronary artery calcifications (CAC) on CTLS exams could identify patients at increased risk for non-cardiovascular events such as all cause, COPD and pneumonia related hospitalization and to verify previously reported associations between CAC and mortality and cardiovascular events. Study design and methodsPatients (n = 4673) from Lahey Hospital and Medical Center who underwent CTLS from January 12, 2012 through September 30, 2017 were included with clinical follow-up through September 30, 2019. CTLS exams were qualitatively scored for the presence and severity of CAC at the time of exam interpretation using a four point scale: none, mild, moderate, and marked. Multivariable Cox regression models were used to evaluate the association between CT qualitative CAC and all-cause, COPD-related, and pneumonia-related hospital admissions. Results3631 (78%) of individuals undergoing CTLS had some degree of CAC on their baseline exam: 1308 (28.0%), 1128 (24.1%), and 1195 (25.6%) had mild, moderate and marked coronary calcification, respectively. Marked CAC was associated with all-cause hospital admission and pneumonia related admissions HR 1.48; 95% CI 1.23–1.78 and HR 2.19; 95% 1.30–3.71, respectively. Mild, moderate and marked CAC were associated with COPD-related admission HR 2.30; 95% CI 1.31–4.03, HR 2.17; 95% CI 1.20–3.91 and HR 2.27; 95% CI 1.24–4.15. ConclusionQualitative CAC on CTLS exams identifies individuals at elevated risk for all cause, pneumonia and COPD-related hospital admissions.

High parathyroid hormone predicts exacerbations in COPD patients with hypovitaminosis D

BackgroundHypovitaminosis D has been linked to deterioration in clinical parameters and lung function in COPD. As a response to low levels of vitamin D serum Parathyroid Hormone (iPTH) is increased in some, but not all, patients. The aim of this study was to determine whether COPD patients with elevated PTH levels are at higher risk of COPD exacerbations and hospitalizations. Methods166 COPD outpatients were randomly preselected. Clinical and analytical characteristics were assessed at baseline. After excluding patients with other conditions known to disturb calcium metabolism 141 patients were identified. Except one, all patients were prospectively followed for 12 months after obtaining the blood samples. Hypovitaminosis D was considered when serum 25(OH)D < 30 ng/mL. Secondary hyperparathyroidism was considered when serum iPTH was higher than normal (50 pg/mL) in patients with hypovitaminosis D. COPD exacerbations and hospital admissions were recorded during the follow-up. ResultsPrevalence of hypovitaminosis D in COPD patients was 89.3%, prevalence of secondary hyperparathyroidism associated with hypovitaminosis D was 22,9%. Cox proportional risk analysis showed that patients belonging to the high iPTH-low 25(OH)D group were at a higher risk of moderate COPD exacerbations (HR 1.81 (CI95% 1.043–3.127), p = 0.035) and hospital admissions (HR 5.45 (CI95% 2.018–14.720), p = 0.002) as compared with those with normal iPTH-low 25(OH)D levels. ConclusionsCOPD patients with hypovitaminosis D and elevated iPTH have higher risk of moderate exacerbations and hospitalizations than those with hypovitaminosis D and normal iPTH.

Acute effects of air pollution on hospital admissions for asthma COPD and bronchiectasis in Ahvaz Iran

Acute effects of air pollution on hospital admissions for asthma, COPD and bronchiectasis in Ahvaz, IranAbstractBackground and Aim: Although, air pollution is a serious problem in Ahvaz, the association between air pollution and respiratory diseases has not been studied enough in this area. The aim of this study was to determine the relation between short-term exposure to air pollutants and the risk of hospital admissions due to asthma, COPD and bronchiectasis in Ahvaz.Methods: Hospital admissions data and air pollutants including O3, NO, NO2, SO2, CO, PM10 and PM2.5 were obtained from 2008 to 2018. Adjusted Quasi-Poisson regression with a distributed lag model, controlled for trend, seasonality, weather, weekdays and holidays was used for data analysis.Results: The results showed a significant increase in hospital admissions for asthma (RR=1.004, 95% CI: 1.002-1.007) and COPD (RR=1.003, 95% CI: 1.001-1.005) associated with PM2.5. PM10 was associated with increased hospital admissions due to bronchiectasis in both genders (Men: RR=1.003, 95% CI: 1.001-1.006), (Female: RR=1.003, 95% CI: 1.000-1.006). NO2 was also associated with an increased risk of hospital admissions for asthma (RR=1.040, 95% CI: 1.008-1.074) and COPD (RR=1.049, 95% CI: 1.010-1.090). SO2 was associated with the risk of hospital admissions of asthma (RR=1.069, 95% CI: 1.017-1.124) and bronchiectasis (RR=1.030, 95% CI: 1.005-1.056). Finally, CO was associated with COPD (RR=1.643, 95% CI: 1.233-2.191) and bronchiectasis (RR=1.542, 95% CI: 1.035-2.298) hospital admissions.Conclusion: Short-term exposure to air pollutants significantly increases the risk of hospital admissions for asthma, COPD and bronchiectasis in the adult and elderly population.Keywords: Air pollution; particulate matter; Asthma; COPD; Bronchiectasis

Information Needs in COPD After an Educational Programme: Influence in Exacerbations and Admissions.

IntroductionImproving patients’ information needs (IN) may contribute to better control in COPD. This study analyses IN using Lung Information Needs Questionnaire (LINQ) following an educational intervention, evaluates how clinical characteristics modify IN, and studies high IN as a prognostic factor for COPD exacerbations and hospital admissions.MethodsCohort of 143 patients with initial diagnosis of COPD included in a structured educational program. Two months after completing the program, IN was assessed using LINQ. Correlations between IN and clinical variables of COPD and distribution of IN in different clinical groups were analyzed. Univariate and multivariate analysis was performed to determine influence of IN on exacerbations and COPD admissions over the following year.ResultsLINQ scored 6.3±2.9. There were no differences in LINQ scoring between different clinical groups, but LINQ score positively correlated with age (r=0.184, p=0.029). High IN was a predictor of COPD hospitalizations (HR 2.3 [95% CI 1.1–5.1] (p=0.029)) but not of less severe exacerbations (p=0.334).ConclusionIN was not associated with any clinical variables, but it correlated with age. High IN proved to be an independent predictor of admissions.

Mapping spatial distribution of traffic induced criteria pollutants and associated health risks using kriging interpolation tool in Delhi

The present study undertakes to understand the spatial influence of traffic-induced criteria air pollutants and associated health risks assessment at major transport corridors in Delhi. The study includes the classification of vehicular pollutants parameters into five different distribution categories, i.e., low, moderately low, moderate, moderately high, and high. Spatial distribution maps were developed using Geographic Information System (GIS) environment for eleven districts covering 36 transport corridors of the city. The study demonstrated the concentration of three out of the five ambient air pollutants, namely, NOx, PM10 and PM2.5, with highest values in the range of 294.10–362.57, 203.99–422.42 and 333.71–541.72 μg/m3, respectively. Corresponding National Ambient Air Quality Standards (NAAQS) values were found to be grossly violated as reflected by NOx, PM2.5 and PM10 concentrations with 2–5 times higher values. Remaining two (CO and SOx) were found to be under permissible limits, and most of them exhibited low levels of observed concentrations. The ambient air quality in south, central, east, and New Delhi areas were found to be in high and moderately high categories and necessitating adequate control measures. The study reported a total of 281107, 20791, 31636 expected cases of human exposure to respiratory mortality, cardiovascular mortality and total mortality, respectively whereas, 281107 and 71608 number of cases were reported in relation to respiratory morbidity in terms of COPD hospital admission and cardiovascular morbidity along the transport corridors. The outcome of the study may provide a basis for decision makers to formulate the policy as per the scale of impact of traffic induced air pollution in critical areas around the major transport corridors.

Serum IgG Levels and Risk of COPD Hospitalization: A Pooled Meta-analysis

Hypogammaglobulinemia (serum IgG levels< 7.0 g/L) has been associated with increased risk of COPD exacerbations but has not yet been shown to predict hospitalizations. To determine the relationship between hypogammaglobulinemia and the risk of hospitalization in patients with COPD. Serum IgG levels were measured on baseline samples from four COPD cohorts (n= 2,259): Azithromycin for Prevention of AECOPD (MACRO, n= 976); Simvastatin in the Prevention of AECOPD (STATCOPE, n= 653), Long-Term Oxygen Treatment Trial (LOTT, n= 354), and COPD Activity: Serotonin Transporter, Cytokines and Depression (CASCADE, n= 276). IgG levels were determined by immunonephelometry (MACRO; STATCOPE) or mass spectrometry (LOTT; CASCADE). The effect of hypogammaglobulinemia on COPD hospitalization risk was evaluated using cumulative incidence functions for this outcome and deaths (competing risk). Fine-Gray models were performed to obtain adjusted subdistribution hazard ratios (SHR) related to IgG levels for each study and then combined using a meta-analysis. Rates of COPD hospitalizations per person-year were compared according to IgG status. The overall frequency of hypogammaglobulinemia was 28.4%. Higher incidence estimates of COPD hospitalizations were observed among participants with low IgG levels compared with those with normal levels (Gray's test, P< .001); pooled SHR (meta-analysis) was 1.29 (95%CI, 1.06-1.56, P= .01). Among patients with prior COPD admissions (n= 757), the pooled SHR increased to 1.58 (95%CI, 1.20-2.07, P< .01). The risk of COPD admissions, however, was similar between IgG groups in patients with no prior hospitalizations: pooled SHR= 1.15 (95%CI, 0.86-1.52, P=.34). The hypogammaglobulinemia group also showed significantly higher rates of COPD hospitalizations per person-year: 0.48 ± 2.01 vs0.29 ± 0.83, P< .001. Hypogammaglobulinemia is associated with a higher risk of COPD hospital admissions.

Acute Effects of Air Pollution on Hospital Admissions for Asthma, COPD, and Bronchiectasis in Ahvaz, Iran.

Background and AimAlthough air pollution is a serious problem in Ahvaz, the association between air pollution and respiratory diseases has not been studied enough in this area. The aim of this study was to determine the relation between short-term exposure to air pollutants and the risk of hospital admissions due to asthma, COPD, and bronchiectasis in Ahvaz.MethodsHospital admissions data and air pollutants including O3, NO, NO2, SO2, CO, PM10, and PM2.5 were obtained from 2008 to 2018. Adjusted Quasi-Poisson regression with a distributed lag model, controlled for trend, seasonality, weather, weekdays, and holidays was used for data analysis.ResultsThe results showed a significant increase in hospital admissions for asthma (RR=1.004, 95% CI: 1.002–1.007) and COPD (RR=1.003, 95% CI: 1.001–1.005) associated with PM2.5. PM10 was associated with increased hospital admissions due to bronchiectasis in both genders (Men: RR=1.003, 95% CI: 1.001–1.006) (Female: RR=1.003, 95% CI: 1.000–1.006). NO2 was also associated with an increased risk of hospital admissions for asthma (RR=1.040, 95% CI: 1.008–1.074) and COPD (RR=1.049, 95% CI: 1.010–1.090). SO2 was associated with the risk of hospital admissions of asthma (RR=1.069, 95% CI: 1.017–1.124) and bronchiectasis (RR=1.030, 95% CI: 1.005–1.056). Finally, CO was associated with COPD (RR=1.643, 95% CI: 1.233–2.191) and bronchiectasis (RR=1.542, 95% CI: 1.035–2.298) hospital admissions.ConclusionShort-term exposure to air pollutants significantly increases the risk of hospital admissions for asthma, COPD, and bronchiectasis in the adult and elderly population.

Short-term effects of ambient air pollution on chronic obstructive pulmonary disease admissions in Beijing, China (2013-2017).

PurposeEvidence between air pollution and COPD admissions is inconsistent and limited in China. In this study, we aimed to explore the effects of air pollutants on COPD admissions in Beijing, China.Patients and methodsDaily COPD hospital admission visits derived from tertiary and secondary hospitals in Beijing were retrieved from January 2013 to February 2017. Air pollutant levels and meteorological data over the same periods were also achieved. Generalized additive model was applied to estimate the percentage changes with 95% CIs in daily admissions corresponding to 10 µg/m3 increases in pollutants levels [1 mg/m3 in carbon monoxide (CO)], stratified by age, gender, and season.ResultsSeventy-three thousand seventy-six COPD hospital admission visits were included with mean daily visits of 48 (21). Cumulative lag effect with per 10 µg/m3 increase in air pollutant levels was largest for nitrogen dioxide (NO2) with 3.03% (95% CI: 1.82%–4.26%) at lag 06, for sulfur dioxide (SO2) with 2.07% (95% CI: 1.00%–3.15%) at lag 01, for particulate matter ≤10 µm in aerodynamic diameter (PM10) with 0.92% (95% CI: 0.55%–1.30%) at lag 07, and for particulate matter ≤2.5 µm in aerodynamic diameter (PM2.5) with 0.82% (95% CI: 0.38%–1.26%) at lag 06, respectively. Percentage increase for each 1 mg/m3 increase in CO was 5.99% (95% CI: 2.74%–9.34%) at lag 06. Further, stronger effects on COPD admissions were found in warm seasons than in cold seasons.ConclusionShort-term exposures to PM2.5, PM10, NO2, SO2, and CO had adverse effects on COPD hospitalizations in Beijing with different magnitudes and lag days.

Greater Access to Long Acting Beta2 Agonists Is Associated with Less Hospital Admissions Due to COPD: A Longitudinal Nation-Wide Study.

Long Acting Beta2 Agonists (LABA) prevent COPD exacerbations in strictly standardized clinical trials. Our aim was to evaluate the relationship between the amount of LABA provided by the government and the trend in COPD hospital admission (HA) rate in Brazil. This is a longitudinal large-scale real-life study. We calculated COPD HA rate and the number of subjects per 105 inhabitant who received LABA supplied by the government in each Brazilian municipality, between years 2004 and 2013. We used Poisson Multilevel Regression analysis to calculate the rate ratio between LABA dispensation rate and COPD HA rate. In Brazil, COPD HA rate reduced 59% among subjects between 40 and 59years of age and 60% among subjects older than 59years of age. Most of the 5506 Brazilian municipalities reduced COPD HA rate [4149 (75%) municipalities & 1357 (25%) municipalities]. The dispensation of LABA was greater among municipalities that reduced COPD HA rate. In the 40-59 age group, the gap in LABA dispensation between the two groups of municipalities increased during the study period from 90.40 to 614.28 subjects per 105 inhabitants. In the > 59 age group, the gap in LABA dispensation increased from 35.87 to 912.99 subjects per 105 inhabitants. For each one hundred subjects who received LABA there was less one HA (RR 0.99, 95 CI 0.99-0.99). COPD HA rate reduced in Brazil. LABA dispensation growth was associated with COPD HA rate reduction.

COPD prevalence and hospital admissions in Galicia (Spain). An analysis using the potential of new health information systems

Introduction and objectivesChronic obstructive pulmonary disease (COPD) is a major public health problem. The aim of this study was to ascertain the prevalence of COPD and whether such prevalence was positively or negatively associated with COPD admissions, using all the data of a regional health care system. Materials and methodsWe designed a descriptive cross-sectional study which included all subjects aged over 45 years, diagnosed with COPD in primary care in 2013. We also calculated the number of such patients who had a record of hospital admissions due to this disease. COPD prevalence and incidence of admissions were calculated. Poisson regression models were then used to analyse the association between cases with diagnosis of COPD and admissions due to COPD, by sex, adjusting for socio-demographic variables and distance to hospital. Sensitivity subanalyses were performed by reference to the respective municipal rurality indices. ResultsMedian municipal prevalence of COPD was 5.29% in men and 2.19% in women. Among patients with COPD, 28.22% of men and 16.00% of women had at least one hospital admission. The relative risk of admission per unit of the standardised prevalence ratio was 0.37 (95% CI 0.34–0.41) for men and 0.39 (95% CI 0.34–0.45) for women. ConclusionsThere is a significant negative association between COPD prevalence and hospital admissions due to this disease. The proportion of admissions is lower in municipalities lying furthest from hospitals. There is considerable municipal variability in terms of COPD prevalence and proportion of admissions. In-depth attention should be given to disease-management training programmes.

Trends in Epidemiology of COPD in HIV-Infected Patients in Spain (1997-2012).

PurposeThe aim of this study was to estimate trends of incidence of hospital admissions and in-hospital mortality (IHM) in HIV-infected patients with COPD in the combination antiretroviral therapy (cART) era in Spain (1997–2012).MethodsA retrospective study with data from nationwide population-based COPD diagnoses in the Spanish Minimum Basic Data Set (MBDS) was performed. We established groups according to their HIV and HCV infections: 1) HIV-uninfected patients; 2) HIV-infected patients (with or without HCV coinfection).Results1,580,207 patients discharge with a COPD diagnosis were included in the study, 8902 of them were HIV-infected patients (5000 HIV-monoinfected patients and 3902 HIV/HCV-coinfected patients). The HIV-infected patients had higher incidence rates of hospital admissions for COPD than the HIV-uninfected patients during the study period. The HIV-monoinfected patients had higher rates of hospitalizations for COPD than the HIV/HCV-coinfected patients in the early-period cART (1997–1999), but these rates decreased in the first group and increased in the second, being even similar in both groups in the late-period cART (2004–2011). On the other hand, the HIV-infected patients with COPD had higher IHM than the HIV-uninfected patients with COPD. The mortality rates were higher in the HIV-monoinfected patients with COPD than in the HIV/HCV-coinfected patients with COPD in the early-period cART; however, in the late-period cART, the mortality rates trends seems higher in the HIV/HCV group. The likelihood of death in HIV/HCV-coinfected patients with COPD was similar to than in HIV-monoinfected patients with COPD.ConclusionsIncidence of hospital admissions for COPD and IHM have decreased among HIV-monoinfected individuals but have increased steadily among HIV/HCV-coinfected individuals in the cART era.

Length of stay of COPD hospital admissions between 2006 and 2010: a retrospective longitudinal study.

BackgroundHospitalizations for COPD are associated with poor patient prognosis. Length of stay (LOS) of COPD admissions in a large urban area and patient and hospital factors associated with it are described.MethodsRetrospective longitudinal study. All COPD patients registered with London general practitioners and admitted as an emergency with COPD (2006–2010), not having been admitted with COPD in the preceding 12 months were included. Association of patient and hospital characteristics with mean LOS of COPD admissions was assessed. Association between hospital and LOS was determined by negative binomial regression.ResultsThe total number of admissions was 38,504, from 22,462 patients. The mean LOS for first admissions fell by 0.8 days (95% confidence interval [CI]: 0.7–1.5) from 8.2 to 7.0 days between 2006 and 2010. Seventy-nine percent of first admissions were ≤10 days, with a mean LOS of 3.7 days (2009–2010). The mean LOS of successive COPD admissions of the same patients was the same or less throughout the study period. The interval between successive admissions fell from a mean of 357 days between the first and second admission to a mean of 19 days after eight admissions. Age accounted for 2.3% of the variance in LOS. Socioeconomic deprivation did not predict LOS. Fewer discharges happened at the weekend (1,893/day) than on weekdays (5,218/day). The mean LOS varied between hospitals, from 4.9 days (95% CI: 3.8–5.9) to 9.5 days (95% CI: 8.6–10.3) when adjusting for clustering, age, sex, and socioeconomic deprivation.ConclusionThe fall in LOS of the first COPD admission between 2006 and 2010 reflects international trends. The stability of LOS in successive admissions suggests that increasing severity of disease does not affect recovery time from an exacerbation. Variations between hospitals of nearly 5 days in LOS for COPD admissions suggests that significant improvements in patient outcomes and in savings in health care utilization could be made in hospitals with longer LOS.