COPD-related Admission Research Articles

Is the incident of once chronic obstructive pulmonary disease related admission a high risk for readmission in the future?

Although it is known that a history of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most important predictor of future risk of AECOPD and readmission to hospitals, there is no scientific evidence that an event of only one chronic obstructive pulmonary disease (COPD)-related admission is a high risk of future readmission. We retrospectively analyzed the association of an incident of one COPD-related admission with future readmission risk. This is a retrospective study. The data of AECOPD-related admissions and readmissions during 5 years were obtained and analyzed for the admission frequencies of patients with AECOPD and an association of the admission history with a future readmission risk. The admission frequency of patients with frequent admission (3 or more admissions within 5 years) was 4.1 times that of those with non-frequent admission (0.95 vs. 0.23 times per person per year). In each calendar year during the 5-year study period, most patients (88.2%) were hospitalized only once, and 11.8% had two or more admissions. Nevertheless, their average number of admissions in each calendar year was 3.3 times that of those who only had one admission each year (3.33 vs. 1.00 times per person per year). More importantly, the positive predictive value for future readmission due to AECOPD was only 14.8% in those who had one admission in the previous year. The patients with the greater readmission risk were those with two or more admissions due to AECOPD in the previous year [crude odds ratio (OR): 4.10, 95% confidence interval (CI): 1.24-13.58 and 7.51, 95% CI: 3.81-16.68]. There is a subtype of frequent admission due to AECOPD, and it can be distinguished by having three or more admissions in the past 5 years or two or more admissions in the previous year. Nevertheless, an incident of admission once a year is not a good predictor of future readmission.

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.

Hospital Admission and Readmission Among US Patients Receiving Umeclidinium/Vilanterol or Tiotropium as Initial Maintenance Therapy for Chronic Obstructive Pulmonary Disease.

IntroductionPatients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations are at risk of further readmissions, increased treatment costs, and excess mortality. This study evaluated inpatient admissions and readmissions in patients receiving initial maintenance therapy with umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO).MethodsThis retrospective, matched cohort study identified patients with COPD who initiated maintenance therapy with UMEC/VI or TIO from Optum’s de-identified Clinformatics Data Mart database between January 1, 2013, and December 31, 2018 (index date defined as earliest dispensing). Eligibility criteria included: ≥ 1 medical claim for COPD pre-index or on the index date; ≥ 12 months of continuous eligibility pre-index; age ≥ 40 years at index; no pre- or post-index asthma diagnosis; and no pre-index claims for medications containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists. Outcomes included time to first on-treatment COPD-related inpatient admission, rate of on-treatment COPD-related admissions, and rate of all-cause and COPD-related readmissions within 30 and 90 days. Propensity score matching was used to adjust for potential confounders.ResultsMatched UMEC/VI and TIO cohorts each included 7997 patients and were balanced on baseline characteristics (mean age 70.9 years; female 47.1–47.6%). Over 12 months, patients initiating UMEC/VI had significantly reduced risk (hazard ratio [95% CI]: 0.87 [0.79, 0.96]; p = 0.006) and rates (rate ratio [95% CI]: 0.80 [0.72, 0.92]; p = 0.008) of COPD-related inpatient admissions compared with TIO. While all-cause readmission rates were similar between treatment cohorts, readmission rates among patients with an initial admission length of stay of 1–3 days were numerically lower for UMEC/VI versus TIO (30-day readmissions: 10.5% vs. 12.4%; 90-day readmissions: 15.5% vs. 19.8%). Similar patterns were observed for COPD-related readmissions.ConclusionsThese findings highlight the real-world benefits of dual therapy with UMEC/VI versus TIO in reducing inpatient admissions and readmissions in patients with COPD, which may translate to lower healthcare costs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00151-y.

Qualitative emphysema and risk of COPD hospitalization in a multicenter CT lung cancer screening cohort study

BackgroundIn the United States, 9 to 10 million Americans are estimated to be eligible for computed tomographic lung cancer screening (CTLS). Those meeting criteria for CTLS are at high-risk for numerous cardio-pulmonary co-morbidities. The objective of this study was to determine the association between qualitative emphysema identified on screening CTs and risk for hospital admission. Study design and MethodsWe conducted a retrospective multicenter study from two CTLS cohorts: Lahey Hospital and Medical Center (LHMC) CTLS program, Burlington, MA and Mount Auburn Hospital (MAH) CTLS program, Cambridge, MA. CTLS exams were qualitatively scored by radiologists at time of screening for presence of emphysema. Multivariable Cox regression models were used to evaluate the association between CT qualitative emphysema and all-cause, COPD-related, and pneumonia-related hospital admission. ResultsWe included 4673 participants from the LHMC cohort and 915 from the MAH cohort. 57% and 51.9% of the LHMC and MAH cohorts had presence of CT emphysema, respectively. In the LHMC cohort, the presence of emphysema was associated with all-cause hospital admission (HR 1.15, CI 1.07–1.23; p < 0.001) and COPD-related admission (HR 1.64; 95% CI 1.14–2.36; p = 0.007), but not with pneumonia-related admission (HR 1.52; 95% CI 1.27–1.83; p < 0.001). In the MAH cohort, the presence of emphysema was only associated with COPD-related admission (HR 2.05; 95% CI 1.07–3.95; p = 0.031). ConclusionQualitative CT assessment of emphysema is associated with COPD-related hospital admission in a CTLS population. Identification of emphysema on CLTS exams may provide an opportunity for prevention and early intervention to reduce admission risk.

UMECLIDINIUM/VILANTEROL (UMEC/VI) COMPARED WITH TIOTROPIUM (TIO) FOR TIME-TO-FIRST INPATIENT ADMISSION AMONG PATIENTS WITH COPD IN A MANAGED CARE POPULATION

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: UMEC/VI has been shown to significantly improve lung function in patients with COPD compared to monotherapy (LAMA or LABA), and UMEC/VI has been associated with lower lifetime medical costs and better cost‑effectiveness than TIO. However, limited evidence is available on the impact of these therapies on hospitalizations, which is the largest medical cost driver for COPD. This study examined the time-to-first and rate of COPD-related inpatient admissions among patients with COPD who initiated maintenance therapy with UMEC/VI versus TIO. METHODS: This retrospective matched cohort analysis of the Optum Clinformatics Data Mart database identified patients initiated on UMEC/VI or TIO between 01/01/2014–12/31/2018. The index date for both cohorts was defined as the first dispensing date. Inclusion criteria were: age ≥40 years at index, continuous enrollment for 12 months pre-index, and ≥1 diagnosis of COPD pre-index or on the index date. Patients with an asthma diagnosis or a dispensing for any ICS-, LABA-, or LAMA-containing controller pre-index were excluded. Propensity score matching was used to balance baseline characteristics between cohorts. Time-to-first COPD-related admission was assessed during the on-treatment post-index period with Kaplan-Meier survival analysis and risk of admission was compared using hazard ratios (HRs) from Cox regression models. Rates of admissions were compared using rate ratios (RRs) from Poisson regression models; confidence intervals (CIs) and p-values were calculated using bootstrap procedures. RESULTS: Among patients who met the study criteria, matched UMEC/VI and TIO cohorts each included 7,997 patients with well-balanced characteristics. In both cohorts the mean age was 71 years and 47% were female; the most common pre-index comorbidities were chronic pulmonary disease (89–90%), hypertension (76%), diabetes (31%), peripheral vascular disorders (31%), and cardiac arrhythmias (30%). COPD-related admissions were significantly delayed and reduced in the UMEC/VI cohort. At 12 months post-index, 24.1% of UMEC/VI users had a COPD-related admission compared to 26.1% of TIO users, corresponding to a 13% lower risk of admission (HR [95% CI]: 0.87 [0.79–0.96]; p=0.006). UMEC/VI users also experienced 20% fewer COPD-related admissions compared to TIO users (RR [95% CI]: 0.80 [0.72–0.92]; p=0.008) over 12 months post-index. CONCLUSIONS: Patients with COPD initiating maintenance therapy with UMEC/VI had significantly lower risk of COPD-related inpatient admission while on treatment compared with those initiating maintenance therapy with TIO. Corresponding rates of COPD-related admissions were also significantly lower for patients treated with UMEC/VI versus TIO. CLINICAL IMPLICATIONS: UMEC/VI as initial maintenance therapy in patients with COPD may reduce and delay hospitalizations. DISCLOSURES: No relevant relationships Added 05/27/2020 by Mei Sheng Duh, source=Web Response, value=Grant/Research Support Removed 05/27/2020 by Mei Sheng Duh, source=Web Response Consultant relationship with GlaxoSmithKline Please note: >$100000 Added 05/01/2020 by Guillaume Germain, source=Web Response, value=Grant/Research Support Employee relationship with GlaxoSmithKline Please note: >$100000 Added 03/16/2020 by Beth Hahn, source=Web Response, value=Ownership interest I am an employee of Analysis Group relationship with GSK Please note: >$100000 Added 05/28/2020 by François Laliberté, source=Web Response, value=Grant/Research Support Consultant relationship with GSK Please note: >$100000 Added 05/22/2020 by Sean MacKnight, source=Web Response, value=Consulting fee No relevant relationships by Chad Moretz, source=Web Response Employee relationship with GlaxoSmithKline Please note: >$100000 Added 05/28/2020 by Riju Ray, source=Web Response, value=Salary Employee relationship with GSK Please note: >$100000 Added 05/27/2020 by Qin Shen, source=Web Response, value=Salary My spouse/partner as a Employee relationship with GSK Please note: >$100000 Added 05/27/2020 by Qin Shen, source=Web Response, value=Salary Hold stocks relationship with GSK Please note: $20001 - $100000 Added 05/27/2020 by Qin Shen, source=Web Response, value=Stocks My spouse/partner as a Hold stocks relationship with GSK Please note: $20001 - $100000 Added 05/27/2020 by Qin Shen, source=Web Response, value=Stocks Employee relationship with GSK Please note: >$100000 Added 05/28/2020 by David Slade, source=Web Response, value=Salary Former Employee relationship with Astra Zeneca Please note: >$100000 Added 05/28/2020 by David Slade, source=Web Response, value=Stock Employee relationship with GSK Please note: >$100000 Added 05/28/2020 by David Slade, source=Web Response, value=Stock Former Employee relationship with Teva Please note: >$100000 Added 05/28/2020 by David Slade, source=Web Response, value=Stock

Roflumilast Usage from 2010 to 2016: A Danish Nationwide Drug Utilization Study.

Roflumilast, a phosphodiesterase-4-inhibitor, is marketed as add-on treatment to inhaled bronchodilators and corticosteroids in COPD patients with frequent exacerbations. Although marketed since 2010, usage pattern of roflumilast for an entire nation has not previously been explored. This study aimed to estimate the total utilization of roflumilast in Denmark during 2010 to 2016, using the Danish nationwide health registers. We identified 1573 individuals (47% males) who used roflumilast during the study period, of whom 705 (45%) redeemed only one prescription. Of all patients initiating roflumilast, 67% discontinued treatment within the first year. The rate of treatment initiation decreased 73% from 2011 (7.5/100,000 person-years) to 2016 (2.0/100,000 person-years) concurrent with a stable prevalence of 3.0-4.0/100,000 persons throughout the study period. The median duration of roflumilast use was 76days. Patients with severe comorbidity tended to exhibit a lower degree of early discontinuation (Charlson Comorbidity Index 3+: odds ratio [OR]: 0.59; 95% confidence interval [CI] 0.33-1.04), as well as patients with a COPD-related admission within a year prior to roflumilast initiation (OR 0.62; 95% CI 0.49-0.80). The decreasing incidence and high level of early roflumilast discontinuation could be due to lack of benefit, a low awareness of romiflulast's indication among physicians, secondary to a challenging prescribing procedure or to adverse effects.

Changes in hospitalizations for chronic respiratory diseases after two successive smoking bans in Spain.

BackgroundExisting evidence on the effects of smoke-free policies on respiratory diseases is scarce and inconclusive. Spain enacted two consecutive smoke-free regulations: a partial ban in 2006 and a comprehensive ban in 2011. We estimated their impact on hospital admissions via emergency departments for chronic obstructive pulmonary disease (COPD) and asthma.MethodsData for COPD (ICD-9 490–492, 494–496) came from 2003–2012 hospital admission records from the fourteen largest provinces of Spain and from five provinces for asthma (ICD-9 493). We estimated changes in hospital admission rates within provinces using Poisson additive models adjusted for long-term linear trends and seasonality, day of the week, temperature, influenza, acute respiratory infections, and pollen counts (asthma models). We estimated immediate and gradual effects through segmented-linear models. The coefficients within each province were combined through random-effects multivariate meta-analytic models.ResultsThe partial ban was associated with a strong significant pooled immediate decline in COPD-related admission rates (14.7%, 95%CI: 5.0, 23.4), sustained over time with a one-year decrease of 13.6% (95%CI: 2.9, 23.1). The association was consistent across age and sex groups but stronger in less economically developed Spanish provinces. Asthma-related admission rates decreased by 7.4% (95%CI: 0.2, 14.2) immediately after the comprehensive ban was implemented, although the one-year decrease was sustained only among men (9.9%, 95%CI: 3.9, 15.6).ConclusionsThe partial ban was associated with an immediate and sustained strong decline in COPD-related admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men.

Self-management support using an Internet-linked tablet computer (the EDGE platform)-based intervention in chronic obstructive pulmonary disease: protocol for the EDGE-COPD randomised controlled trial

IntroductionThe potential for telehealth-based interventions to provide remote support, education and improve self-management for long-term conditions is increasingly recognised. This trial aims to determine whether an intervention delivered through an...

Costs of inpatient and emergency department care for chronic obstructive pulmonary disease in an elderly Medicare population

Objective:Treatment in the hospital setting accounts for the largest portion of healthcare costs for COPD, but there is little information about components of hospital care that contribute most to these costs. The authors determined the costs and characteristics of COPD-related hospital-based healthcare in a Medicare population.MethodsUsing administrative data from 602 hospitals, 2008 costs of COPD-related care among Medicare beneficiaries age ≥65 years were calculated for emergency department (ED) visits, simple inpatient admissions and complex admissions (categorized as intubation/no intensive care, intensive care/no intubation, and intensive care/intubation) in a cross-sectional study. Rates of death at discharge and trends in costs, length of stay and readmission rates from 2005 to 2008 also were examined.Main results:There were 45,421 eligible healthcare encounters in 2008. Mean costs were $679 (SD, $399) for ED visits (n = 10,322), $7,544 ($8,049) for simple inpatient admissions (n = 25,560), and $21,098 ($46,160) for complex admissions (n = 2,441). Intensive care/intubation admissions (n = 460) had the highest costs ($45,607, SD $94,794) and greatest length of stay (16.3 days, SD 13.7); intubation/no ICU admissions had the highest inpatient mortality (42.1%). In 2008, 15.4% of patients with a COPD-related ED visit had a repeat ED visit and 15.5–16.5% of those with a COPD-related admission had a readmission within 60 days. From 2005 to 2008, costs of admissions involving intubation increased 10.4–23.5%. Study limitations include the absence of objective clinical data, including spirometry and smoking history, to validate administrative data and permit identification of disease severity.Conclusions:In this Medicare population, COPD exacerbations and related inpatient and emergency department care represented a substantial cost burden. Admissions involving intubation were associated with the highest costs, lengths of stay and inpatient mortality. This population needs to be managed and treated adequately in order to prevent these severe events.