COPD-related Hospitalizations Research Articles

Chronic Obstructive Pulmonary Disease Outcomes Among Individuals in Japan Who Switched to Heated Tobacco Products Compared to Those Who Continued Smoking or Formerly Smoked Combustible Cigarettes: Protocol for a Real-World Retrospective Study.

Chronic obstructive pulmonary disease (COPD) is a debilitating respiratory disease that is highly associated with smoking. Despite widespread knowledge of the health risks of smoking, many patients with COPD continue to smoke. Growing evidence suggests that alternatives to combustible cigarettes (CIG), such as heated tobacco products (HTP), may be less harmful. To evaluate the impact of switching from CIG to HTP on the time to subsequent COPD exacerbations in patients who have had a COPD-related hospitalization. This retrospective cohort study will be conducted in Japan using electronic health data and tobacco exposure data from questionnaires and consumer databases. The study will invite approximately 30,000 patients who had a COPD-related hospitalization between May 2016 and December 2022. The first of these hospitalizations will be considered a patient's study Index Event. The primary outcome is the time from Index Event to subsequent COPD exacerbation (a composite outcome of subsequent COPD-related hospitalization and all-cause mortality); patients will be observed until March 2025. The primary exposure groups are HTP use and CIG use, respectively, pre- and post-index. We will use weighted Cox proportional hazard models, with propensity score weighting to balance potential confounders, to compare the primary outcome between the primary exposure groups. We will also compare the primary outcome between exclusive HTP users and ancillary exposure groups of dual users of CIG and HTP and former CIG smokers. Secondary outcomes include all-cause mortality, pneumonia-related hospitalization, COPD-related hospitalizations, and all-cause hospitalizations and will be assessed in primary and ancillary exposure groups. The study described in this protocol intends to assess whether there is a longer time to subsequent COPD hospitalizations and all-cause mortality for HTP users compared to CIG smokers. This protocol describes the first large-scale study that will identify patients with COPD from a nationally representative healthcare database and evaluate the history of tobacco product usage from multiple sources. Additionally, this study protocol is the first in the tobacco medical literature that embraces real-world data providing information on HTP use from various tobacco product exposure sources. This will also be the first study to assess the relationship between HTP use and mortality in this patient population. Given the limited evidence on the health effects of HTP in COPD, the results of this study will provide real-world insights into the effects of switching to HTP use compared to continued CIG smoking in patients with COPD. Not applicable.

The Effect of Respiratory Therapist Case Managers Integrated into COPD Clinical Care.

Background: Personalized education and treatment selection can improve health behaviors and outcomes in patients with COPD. However, many patients with COPD have incomplete knowledge of their disease, which leads to undertreated symptoms. We hypothesized that an interdisciplinary care approach to COPD with respiratory therapists (RTs) integrated in our dedicated clinic will significantly affect care as measured by COPD Assessment Test (CAT) scores, exacerbation rates, and COPD-related hospitalizations. Methods: This study was a retrospective analysis of patients enrolled in the UC Davis Comprehensive COPD Clinic registry. Between January 2018-January 2020, 241 patients were seen. Patients screened (n = 101) had been followed 12 months post initial COPD clinic visit. Two subjects were excluded from analysis due to discrepancies in CAT assessments, leaving 99 subjects in total. The clinic RT provided assessment, education, and treatment recommendations. We collected CAT scores, exacerbation rates, and those that required hospitalization in the 12 months prior to and after the initial COPD clinic visit. Analysis for CAT is reported as median and interquartile range (IQR), with differences determined by Wilcoxon test. Summary data are reported as percentages, 95% CI, and chi-square test. Results: The initial median CAT score was 22 (IQR 7-34), and 2-month follow-up CAT median was 19 (IQR 11-24, P < .001). There were 115 exacerbations in the 12-month period prior to the initial clinic visit and 63 exacerbations in the 12 months post clinic visit (P = .006). In the 12-month period prior to the clinic visit, there were 44 hospital admissions for COPD exacerbations compared to 20 hospital admissions for COPD exacerbations in the 12 months after initial clinic visit (P = .06). Conclusions: Our retrospective study demonstrated significant improvements in symptoms and exacerbation rates and a non-significant reduction in hospitalizations for COPD. This suggests that an RT-facilitated program may improve meaningful clinical outcomes.

Air Pollution and COPD: Unveiling Hidden Risks of Mortality, Mechanical Ventilation, and Prolonged Hospitalization

While the impact of air pollution on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has been widely studied, its effect on hospitalization outcomes remains less explored. This study examines the influence of short-term air pollution exposure on adverse hospitalization outcomes—mortality, mechanical ventilation use, and prolonged hospitalization—in patients with non-infectious severe AECOPD in Novi Sad, Serbia. Using a five-year time-series analysis, concentrations of selected air pollutants (PM10, PM2.5, SO2, and NO2) and meteorological data were integrated with hospitalization outcomes. Distributed lag non-linear models (DLNMs) revealed significant associations between rising air pollutant levels and some unfavorable outcomes. Exposure to rising PM2.5 (urban background) and SO2 (urban traffic) concentrations were linked to higher risks of mechanical ventilation (cumulative OR 21.95 (95% CI 1.07–449.45) and 11.37 (95% CI 1.25–103.27), respectively) and prolonged non-infectious AECOPD hospitalization (cumulative RR 2.27 (95% CI 1.14–4.52) and 2.24 (95% CI 1.38–3.64), respectively). No cumulative lag effects on mortality were observed, though specific patterns emerged in individual lag models. These findings highlight the critical role of improving air quality in reducing some COPD-related hospitalization risks.

Fluticasone Furoate/Umeclidinium/Vilanterol Initiation Following a COPD Exacerbation: Benefits of Prompt Initiation on COPD Outcomes.

Previous real-world evidence suggests that prompt versus delayed initiation of single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) following an exacerbation results in improved clinical outcomes for patients with chronic obstructive pulmonary disease (COPD). This prior study was conducted in the first 2years following FF/UMEC/VI approval, representing early trends. The current updated analysis aims to further elucidate the real-world evidence for FF/UMEC/VI. This was a retrospective cohort study using the IQVIA PharMetrics® Plus database. Patients with COPD initiating SITT with FF/UMEC/VI within 6months of an exacerbation (index date) were classified as prompt (≤ 30days following exacerbation) or delayed (31-180days) initiators. The baseline period comprised the 12months prior to index. Inverse probability of treatment weighting was used to balance differences in baseline characteristics between cohorts. COPD exacerbations, hospital readmission rates, and healthcare costs were compared between cohorts post-index. Overall, 5421 patients (prompt, 2057; delayed, 3364) were included. After weighting, baseline characteristics were well balanced between cohorts. For up to 12months post-index, prompt initiators of FF/UMEC/VI had significantly lower rates of exacerbations per person-year versus delayed initiators (0.74 vs. 1.06; rate ratio 0.70, 95% confidence interval [CI] 0.64-0.77; P < 0.001). A 1-day delay in FF/UMEC/VI initiation was associated with a 0.31% increase in the rate of exacerbations. At 90days post-index, Kaplan-Meier rates of all-cause (hazard ratio [HR] 0.62, 95%CI 0.45-0.86; P = 0.004) and COPD-related (HR 0.58, 95%CI 0.35-0.98; P = 0.042) hospital readmissions were significantly lower in the prompt versus delayed cohort. Total COPD-related healthcare costs per person per year were significantly lower for patients in the prompt versus delayed cohort. Healthcare providers should consider the positive impact of prompt FF/UMEC/VI initiation on exacerbation rate, hospital readmission rate, and costs when treating patients with COPD at risk of exacerbations.

Patient characteristics and mortality across diagnostic settings in COPD

BackgroundMany patients with chronic obstructive pulmonary disease (COPD) are diagnosed late, e.g., at first acute exacerbation of COPD (AECOPD). AECOPD increases the risk of death. We aim to investigate patient characteristics and mortality across diagnostic settings among patients with COPD. MethodsThis nationwide Danish study allocated 107,023 patients with a first-time registered COPD-related hospital contact between 2010 and 2018 based on diagnostic setting: primary care (prior inhalation medication use), hospital outpatient clinic or hospital admission. Multivariable logistic regression was employed to investigate patient characteristics and mortality across these diagnostic settings. ResultsIn total, 81,035 (75.7 %) patients were diagnosed in primary care, median age 63 years (interquartile range (IQR) 53–71); 11,302 (10.6 %) at an outpatient clinic, median age 68 years (IQR 60–76), and 14,686 (13.7 %) during hospital admission, median age 73 years (IQR 65–81). Patient characteristics associated with diagnosis during hospital admission encompassed age (odds ratio (OR) 1.05, 95 % confidence interval (CI) 1.05–1.05, p < 0.001), male sex (OR 1.14, CI 1.10–1.19, p < 0.001), and number of comorbidities, which increased from one comorbidity (OR 2.64, CI 2.50–2.79, p < 0.001) to six or more comorbidities (OR 12.37, CI 11.26–13.60, p < 0.001). Diagnosis during hospital admission due to AECOPD was associated with increased one-year mortality (OR 1.24, CI 1.16–1.33, p < 0.001) compared to diagnosis in primary care. ConclusionPatients diagnosed with COPD in hospital settings were generally older, predominantly male, and had more comorbidities. Patients diagnosed in primary care prior to their first AECOPD admission had higher one-year survival.

Relationship between continuity of primary care and hospitalisation for patients with COPD: population-based cohort study from South Korea

ObjectivesThe existing evidence for the impacts of continuity of care (COC) in patients with chronic obstructive pulmonary disease (COPD) is low to moderate. This study aimed to investigate the associations...

Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study

BackgroundSevere exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of...

Factors affecting 12-month unplanned readmissions for chronic obstructive pulmonary disease patients: the effect of mental disorders in an Australian cohort.

Many individuals with chronic obstructive pulmonary disease (COPD) experience frequent hospitalization and readmissions, which is burdensome on the health system. This study aims to investigate factors associated with unplanned readmissions and mortality following a COPD-related hospitalization over a 12-month period in Australia, focusing on mental disorders and accounting for the acute phase of the COVID-19 pandemic. A retrospective cohort study using linked hospitalization and mortality records identified individuals aged ≥40years who had at least one hospital admission with a principal diagnosis of COPD between 2014 and 2020 in New South Wales, Australia. A semi-competing risk analysis was conducted to examine factors associated with unplanned readmission and mortality. Adults with a mental disorder diagnosis, specifically anxiety, had a higher risk of 12-month unplanned readmission. Individuals with anxiety and dementia also had a higher risk of mortality pre- and post-unplanned readmission. Individuals who were admitted during the acute phase of the COVID-19 pandemic period had lower risk of unplanned readmission, but higher risk of mortality without unplanned readmission. Interventions aimed at reducing admissions should consider adults living with mental disorders such as anxiety or dementia to improve healthcare delivery and health outcomes for individuals living with COPD.

National trend in the prevalence and mortality of COPD in South Korea from 2008 to 2017

BackgroundExisting studies on chronic obstructive pulmonary disease (COPD) in Korea lack full population coverage, relying on small sample sizes. Therefore, this study aims to investigate the prevalence and mortality of...

Muscle loss phenotype in COPD is associated with adverse outcomes in the UK Biobank

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both muscle and fat mass. There are limited data comparing the individual traits of MLP with clinical outcomes in a large unbiased cohort of COPD patients. Our aim was to determine the proportion of patients who met criteria for MLP in an unbiased sample of COPD patients at the population-level. We also determined if specific MLP features were associated with all-cause and COPD-related mortality.MethodsA retrospective population-based cohort analysis of the UK Biobank was performed. COPD was defined by a FEV1/FVC ratio < 0.7, physician established diagnosis of COPD, or those with a COPD-related hospitalization before baseline assessment. MLP included one or more of the following: 1) Low fat-free mass index (FFMI) on bioelectric impedance analysis (BIA) or 2) Appendicular skeletal muscle index (ASMI) on BIA, 3) Low muscle strength defined by handgrip strength (HGS), or 4) Low muscle and fat mass based on body mass index (BMI). Cox regression was used to determine the association between MLP and all-cause or COPD-related mortality. All models were adjusted for sex, age at assessment, ethnicity, BMI, alcohol use, smoking status, prior cancer diagnosis and FEV1/FVC ratio.ResultsThere were 55,782 subjects (56% male) with COPD followed for a median of 70.1 months with a mean(± SD) age at assessment of 59 ± 7.5 years, and FEV1% of 79.2 ± 18.5. Most subjects had mild (50.4%) or moderate (42.8%) COPD. Many patients had evidence of a MLP, which was present in 53.4% of COPD patients (34% by ASMI, 26% by HGS). Of the 5,608 deaths in patients diagnosed with COPD, 907 were COPD-related. After multivariate adjustment, COPD subjects with MLP had a 30% higher hazard-ratio for all-cause death and 70% higher hazard-ratio for COPD-related death.ConclusionsEvidence of MLP is common in a large population-based cohort of COPD and is associated with higher risk for all-cause and COPD-related mortality.

The effect of an educational program on wellbeing and symptom control of hospitalized chronic obstructive pulmonary disease patients in Jordan

ABSTRACT This study was conducted to determine what impact a structured nurse-led educational program has on patient self management and symptom control of hospitalized Chronic Obstructive Pulmonary Disease (COPD) patients in Jordan. An experimental design was used to guide data collection from 100 COPD patients who were randomly assigned to the intervention (n = 50) and control groups (n = 50). Participants in the intervention group underwent a two-week health education program that discussed smoking, medications and how to use them, exercise, and diet. A COPD educational pamphlet was also provided. Participants in the control group received only routine health education. A COPD Assessment Test (CAT) was used to measure the impact of the COPD educational program on wellbeing. The test consists of eight short questions covering cough, sputum production, chest tightness, breathlessness, activity limitations at home, confidence leaving home, sleep, and energy. The independent samples t-test findings revealed a significant difference between the two groups in relation to the post-test results (p = 0.039), with a 95 percent confidence interval −25.24 to −6.46, providing empirical support for the educational program’s success. Moreover, and as compared to the control group, participants in the intervention group showed significantly fewer COPD-related hospital admissions (p = .033). These programs should be integral components of a nurse-led COPD clinic to improve patients’ experience with the disease and reduce the risk of readmission, resulting in reduced cost and improved quality of life.

Nontuberculous mycobacterial pulmonary disease added burden to COPD and bronchiectasis in Japan.

Nontuberculous mycobacterial pulmonary disease (NTM-PD) prevalence in Japan is among the highest worldwide. COPD and bronchiectasis are common comorbidities among patients with NTM-PD, and it is challenging to treat NTM-PD in patients with these conditions. There are limited data on the incremental burden that NTM-PD adds to underlying COPD or bronchiectasis in Japan. Therefore, the objective of this study was to assess the incremental burden associated with NTM-PD in patients with pre-existing COPD and/or bronchiectasis. This nested case-control study was based on JMDC, Inc. claims data (2015-2020). Patients with COPD and/or bronchiectasis with NTM-PD (cases) were age and sex matched 1:3 to patients with COPD and/or bronchiectasis without NTM-PD (controls), resulting in three mutually exclusive patient groups (COPD, bronchiectasis or both; with or without NTM-PD). Incremental burden of NTM-PD was assessed within each group by comparing hospitalisations during the 1-year period after NTM-PD diagnosis (index) between cases and controls with both univariate analysis and multivariate analysis adjusting for pre-index comorbidities. Univariate analyses in the three patient groups consistently demonstrated incremental hospitalisation burden in cases versus controls (e.g. COPD group: 20% of 492 cases versus 13% of 1476 controls had all-cause hospitalisations; 11% versus 5% had respiratory-related hospitalisations; and 6% versus 2% had COPD-related hospitalisations). Subsequent multivariate analysis further confirmed the findings. The substantial incremental burden of hospitalisation associated with NTM-PD in patients with COPD and/or bronchiectasis highlights the urgent need for appropriate management of NTM-PD in Japan.

Comprehensive care plans for patients with Chronic Obstructive Pulmonary Disease (COPD): Effect on health services utilization

RATIONALE There is limited real-world evidence on evaluation of chronic disease management initiatives provided by general physicians to patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES We aimed to evaluate changes in COPD-related healthcare resource utilization between COPD patients who had general physician’s provided comprehensive annual care plan (CACP) and those who did not have CACP. METHODS We conducted a retrospective cohort study using health administrative data (Alberta) from 2009 to 2016. COPD patients who received a CACP were identified and matched with two control patients based on age, sex, provider, date of service and qualifying comorbidities. Controlled interrupted-time series analysis was used to evaluate changes in COPD-specific hospitalizations, emergency department (ED) visits, physician visits and claims for pulmonary function test (PFT). Immediate and temporal changes were calculated for the difference in outcomes 1 year before and 1 year after receiving the CACP for the intervention group and matched controls. RESULTS Eligible patients (N = 88,002), of whom 35,847 had received CACPs were matched to a total of 52,155 controls. In 1 year after the CACPs implementation the number of COPD-related hospitalization visits significantly increased by 105.33 (95% CI 58.17-152.49), ED visits increased by 172.65 (95% CI 168.09–177.20), general practitioners (GP) visits increased by 359.53 (95% CI 247.64–471.41), specialist visits increased by 77.21 (95% CI 31.58–122.85) and PFT claims increased by 50.82 (95% CI 35.33–66.30) when compared to the controls who did not receive CACP per 10,000 patients per month. However, only increase in ED and specialist visits was confirmed by the sensitivity analysis. CONCLUSIONS Annual care plans provided by physicians were found to be associated with a statistically significant increase in COPD-related events (including ED visits) in the following year; however, clinical significance was minimal.

Cluster randomised controlled trial of specialist-led integrated COPD care (INTEGR COPD)

ObjectiveStudies in hospital settings demonstrate that there is greater guideline adherence when care is delivered by a respiratory specialist, however, this has not been explored in primary care. The aim...

Clinical and economic burden of anxiety/depression among older adult COPD patients: evidence from the COPD-AD China Registry study.

Anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), especially older adult patients. This can complicate the disease progression and lead to increased clinical and economic burden. We sought to investigate the clinical and economic burdens associated with the presence of anxious and/or depressive symptoms among older adult COPD patients. We screened 579 patients aged over 60 years and diagnosed with COPD via a lung function test following the 2017 Global Initiative Chronic Obstructive Lung Disease (GOLD) guidelines. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) through face-to-face interviews at admission. Follow-up was conducted by telephone calls at 6, 12, 18, 24, and 36 months after discharge to assess clinical and economic burden. COPD-anxiety and/or depression patients were matched to patients without anxiety and depression (COPD-only) using propensity scores. Multivariate regression models were used to compare clinical and economic burden between COPD-anxiety and/or depression and COPD-only groups. Compared with COPD-only patients, COPD patients complicated with anxiety and/or depression had increased clinical burden, including higher COPD-related outpatient visits, COPD-related hospitalizations, and length of COPD-related hospitalizations (p < 0.001). Moreover, they also had an increased economic burden, including higher annual total healthcare costs, medical costs, and pharmacy costs (p < 0.001). Older adult COPD patients with anxiety or depression had significantly higher clinical and economic burdens than patients without these comorbidities. These findings deserve further exploration and may be useful for the formulation of relevant healthcare policies.

Increased Risk of Incident Chronic Obstructive Pulmonary Disease and Related Hospitalizations in Tuberculosis Survivors: A Population-Based Matched Cohort Study.

Tuberculosis (TB) survivors have an increased risk of developing chronic obstructive pulmonary disease (COPD). This study assessed the risk of COPD development and COPD-related hospitalization in TB survivors compared to controls. We conducted a population-based cohort study of TB survivors and 1:1 age- and sex-matched controls using data from the Korean National Health Insurance Service database collected from 2010 to 2017. We compared the risk of COPD development and COPD-related hospitalization between TB survivors and controls. Of the subjects, 9.6% developed COPD, and 2.8% experienced COPD-related hospitalization. TB survivors had significantly higher COPD incidence rates (36.7/1,000 vs. 18.8/1,000 person-years, P < 0.001) and COPD-related hospitalization (10.7/1,000 vs. 4.3/1,000 person-years, P < 0.001) than controls. Multivariable Cox regression analyses revealed higher risks of COPD development (adjusted hazard ratio [aHR], 1.63; 95% confidence interval [CI], 1.54-1.73) and COPD-related hospitalization (aHR, 2.03; 95% CI, 1.81-2.27) in TB survivors. Among those who developed COPD, the hospitalization rate was higher in individuals with post-TB COPD compared to those with non-TB COPD (10.7/1,000 vs. 4.9/1,000 person-years, P < 0.001), showing an increased risk of COPD-related hospitalization (aHR, 1.84; 95% CI, 1.17-2.92). TB survivors had higher risks of incident COPD and COPD-related hospitalization compared to controls. These results suggest that previous TB is an important COPD etiology associated with COPD-related hospitalization.

Decreasing COPD-related incidences and hospital admissions in a German health insurance population

Chronic obstructive pulmonary disease (COPD) is associated with smoking and work-related health hazards. Most studies have reported prevalences, and the number of studies examining incidences and social inequalities is small. We analyzed the development of social inequalities of COPD-incidences in terms of income and exacerbations in terms of hospital admissions. Findings were based on claims data from a German statutory health insurance covering 2008 to 2019. Outpatient diagnoses were used for defining COPD-cases, hospital admissions were used for detecting exacerbations. Analyses were performed using Cox-regression. Individual incomes were depicted at three levels defined according to national averages for each year. Data of 3,040,137 insured men and women were available. From 2008 to 2019 COPD-incidences in men decreased by 42% and 47% in women. After stratification by income the reduction at the lowest income level was 41% and 50% in women. Respectively, at the highest income level reductions were 28% and 41%. Disease exacerbations decreased over time, and also social inequalities between income groups emerged. COPD-rates decreased over time at all income levels, but at a faster pace in the lowest income group, thus leading to a positive development of diminishing social gradients in men as well as in women.

Intensive out-of-hospital coaching for frequently hospitalized COPD patients: a before-after feasibility study.

This study assesses whether out-of-hospital coaching of re-hospitalized, severe COPD patients by specialized respiratory nurses is feasible in terms of cost-effectiveness, implementation, and recipient acceptability. The coaching was aimed at improving patients' health management abilities, motivation for healthy behavior, strengthening the professional and informal care network, stimulating physiotherapy treatment and exercise training, improving knowledge on symptom recognition and medication use, and providing safety and support. Cost-effectiveness of 6 months of out-of-hospital coaching was assessed based on a before-after intervention design, with real-life data and one-year follow-up. A total of 170 patients were included. Primary (questionnaires, meeting reports) and secondary data (insurance reimbursement data) were collected in one province in the Netherlands. The implementing and recipient acceptability was assessed based on the number of successfully delivered coaching sessions, questionnaire response rate, Patient Reported Experience Measure, and interviews with coaches. Post-intervention, the COPD-related hospitalization rate was reduced by 24%, and patients improved in terms of health status, anxiety, and nutritional status. Patients with a high mental burden and a poor score for health impairment and wellbeing at the start of the intervention showed the greatest reduction in hospitalizations. The coaching service was successfully implemented and considered acceptable by recipients, based on patient and coach satisfaction and clinical use of patient-reported measures. The study demonstrates the value of coaching patients out-of-hospital, with a strong link to primary care, but with support of hospital expertise, thereby adding to previous studies on disease- or self-management support in either primary or secondary care settings. Patients benefit from personal attention, practical advice, exercise training, and motivational meetings, thereby improving health status and reducing the likelihood of re-hospitalization and its associated costs.

Systematic Review and Meta-Analysis of Psychological Distress and Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Consequences.

People with chronic obstructive pulmonary disease (COPD) occasionally develop acute exacerbation of COPD-a potentially fatal condition. Psychological distress was associated with acute exacerbation of COPD. However, the evidence on the effect of psychological distress on acute exacerbation of COPD remains unclear. The aim of this study was to explore the influence of psychological distress on acute exacerbation of COPD and its consequences. The current review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, CINAHL, and PsyINFO) that were searched to identify relevant articles. Pooled risk ratios and 95% confidential interval were calculated from the included studies' data with random-effect methods to estimate the effect of psychological distress on acute exacerbation of COPD and its consequences. Nineteen articles were included in the review. Most revealed that psychological distress was significantly associated with increased risk of acute exacerbation of COPD and its consequences. The meta-analyses showed that psychological distress increased risk of acute exacerbation of COPD, COPD-related hospitalization, and death. Psychological distress had negative effects on acute exacerbation of COPD and its consequences. The results of the meta-analyses show that persons with COPD and psychological distress had a greater risk of acute exacerbation of COPD, hospitalization, and death.

Benefit of prompt initiation of single-inhaler fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) in patients with COPD in England following an exacerbation: a retrospective cohort study

BackgroundTriple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite dual therapy. The optimal timing of triple therapy following an exacerbation of COPD is unknown. The outcomes of prompt (≤ 30 days) vs. delayed (31–180 days) initiation of single-inhaler triple therapy with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) following an exacerbation of COPD were examined.MethodsThis was a retrospective cohort study of linked English primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Patients aged ≥ 35 years with COPD were indexed on the first and/or earliest date of exacerbation between November 15, 2017 and March 31, 2019 with subsequent FF/UMEC/VI initiation within 180 days. Patients were required to be continuously registered with a general practitioner for ≥ 12 months prior to and following index. Subsequent exacerbations, direct medical costs, and hospital readmissions were compared between prompt and delayed initiators. Inverse probability of treatment weighting was used to adjust for measured confounders between cohorts.ResultsOverall, 1599 patients were included (prompt: 393, delayed: 1206). After weighting, prompt initiators had numerically lower moderate/severe exacerbations compared with delayed initiators (rate ratio: 0.87, 95% confidence interval [CI]: 0.76–1.01, p = 0.0587). Both all-cause and COPD-related 30-day hospital readmissions were significantly lower among patients with prompt initiation compared with delayed initiators (all-cause: 23.6% vs. 34.6%, odds ratio [95% CI]: 0.58 [0.36–0.95], p = 0.0293; COPD-related: 20.3% vs. 30.6%, odds ratio [95% CI]: 0.58 [0.35–0.96], p = 0.0347). Prompt initiators also had numerically lower all-cause total costs and significantly lower COPD-related costs per-person-per year compared with delayed initiators (COPD-related: £742 vs. £801, p = 0.0016).ConclusionPrompt initiation of FF/UMEC/VI following a moderate/severe exacerbation was associated with fewer subsequent exacerbations, fewer hospital readmissions, and lower COPD-related medical costs compared with delayed initiation.