Hospital Admission For Acute Exacerbation Research Articles

Hospital Admission Rates in Patients with COPD Throughout the COVID-19 Pandemic.

Several studies report decreased hospital admissions for acute exacerbations of COPD (AECOPD) during the COVID-19 pandemic. However, there are no studies that compare AECOPD admissions with admissions for respiratory infections, including COVID-19. This study aimed to examine hospital admission rates for AECOPD, pneumonia, influenza, and COVID-19 among COPD patients, before and during the COVID-19 pandemic. We obtained anonymized data on hospital admissions of patients with COPD and a primary diagnosis code for AECOPD, pneumonia, influenza, or COVID-19, from the hospital patient admission register at a large Swedish hospital. The study compared the pandemic period (February 2020-March 2022) to a period before the pandemic (June 2017-January 2020). Sequential phases of the pandemic were evaluated separately. Monthly admission rates were compared using Poisson regression, controlling for admission month. Comparing monthly admission rates during the pandemic with the prepandemic period, incidence rate ratios were 0.72 for AECOPD (95% CI 0.67-0.77; p<0.001), 0.56 for pneumonia (95% CI 0.49-0.62; p<0.001), 0.18 for influenza during the winter period (95% CI 0.10-0.30; p<0.001) and 0.79 for total COPD admissions, including COVID-19 (95% CI 0.75-0.84; p<0.001). The study showed significantly lower rate ratios for AECOPD, pneumonia, and total COPD admissions during the first, second, third, and fifth (Omicron) waves. No significant effect on admissions was seen after the withdrawal of restriction measures. There was a significant reduction in the overall rate of hospital admissions among COPD patients for AECOPD, pneumonia, and respiratory viral infections during the pandemic despite the rise in COVID-19 admissions. However, prepandemic admission levels returned in the post-restriction period.

Patient and Health Care Provider Perspectives on Potential Preventability of Hospital Admission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Qualitative Study.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease partly characterised by the occurrence of acute exacerbations (AECOPD). The need for hospital admissions for COPD exacerbations could theoretically be decreased through timely and appropriate outpatient care or self-management. The aim of this study is to explore and compare patients' and health care providers' (HCP) perspectives on the potential preventability of COPD hospitalisations and to identify strategies to prevent unnecessary hospitalisations. Semi-structured interviews were conducted with patients admitted for an AECOPD (N = 11), HCPs on the respiratory ward (N = 11), and treating pulmonologists (N = 10). Interviews were transcribed verbatim and analysed using thematic content analysis. Patient and HCP perspectives on the potential preventability of hospital admissions for AECOPD often conflict. The kappa coefficients were -0.18 [95% CI: -0.46-0.11] for patients and pulmonologists and -0.28 [95% CI: -0.80-0.21] for patients and HCPs, which indicates poor agreement. The kappa coefficient for pulmonologists and HCPs was 0.14 [95% CI: -0.13-0.41], which indicates slight agreement. Patient and HCP factors that could potentially prevent hospitalisation for AECOPD were identified, including timely calling for help, recognizing and acting on symptoms, and receiving instruction about COPD, including treatment and action plans. Patients and their HCPs have different beliefs about the potential preventability of AECOPD hospitalisations. Most patients and HCPs mentioned factors that potentially could have led to a different outcome for the current AECOPD or that could impact the patient's health status and treatment of AECOPDs in the future. The factors identified in this study indicate that shared decision making is crucial to center the patient's perspective and individual needs and to provide timely treatment or prevention of AECOPD, thereby potentially decreasing hospital admission rates.

Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France.

BackgroundA global reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) was observed during the first months of the COVID-19 pandemic. Large-scale studies covering the entire pandemic period are lacking. We investigated hospitalizations for AECOPD and the associated in-hospital mortality at the national level in France during the first 2 years of the pandemic.MethodsWe used the French National Hospital Database to analyse the time trends in (1) monthly incidences of hospitalizations for AECOPD, considering intensive care unit (ICU) admission and COVID-19 diagnoses, and (2) the related in-hospital mortality, from January 2016 to November 2021. Pandemic years were compared with the pre-pandemic years using Poisson regressions.ResultsThe database included 565,890 hospitalizations for AECOPD during the study period. The median age at admission was 74 years (interquartile range 65–83), and 37% of the stays concerned women. We found: (1) a dramatic and sustainable decline in hospitalizations for AECOPD over the pandemic period (from 8,899 to 6,032 monthly admissions, relative risk (RR) 0.65, 95% confidence interval (CI) 0.65–0.66), and (2) a concomitant increase in in-hospital mortality for AECOPD stays (from 6.2 to 7.6% per month, RR 1.24, 95% CI 1.21–1.27). The proportion of stays yielding ICU admission was similar in the pre-pandemic and pandemic years, 21.5 and 21.3%, respectively. In-hospital mortality increased to a greater extent for stays without ICU admission (RR 1.39, 95% CI 1.35–1.43) than for those with ICU admission (RR 1.09, 95% CI 1.05–1.13). Since January 2020, only 1.5% of stays were associated with a diagnosis of COVID-19, and their mortality rate was nearly three-times higher than those without COVID-19 (RR 2.66, 95% CI 2.41–2.93).ConclusionThe decline in admissions for AECOPD during the pandemic could be attributed to a decrease in the incidence of exacerbations for COPD patients and/or to a possible shift from hospital to community care. The rise in in-hospital mortality is partially explained by COVID-19, and could be related to restricted access to ICUs for some patients and/or to greater proportions of severe cases among the patients hospitalized during the pandemic.

Hospitalization and mortality for acute exacerbation of asthma: an Italian population-based study.

Asthma is an ever-increasing disease with a highly variable prevalence among different ethnic groups. Information on hospital admission for acute exacerbation of asthma in adult patients and data regarding short-term prognosis of these patients are limited. We, thus, performed an epidemiological study on hospital admission for asthma acute exacerbation in Italy using hospital discharge database records derived from all Italian hospitals. Patients > 15years old were identified using clinical Modification (ICD-9-CM) codes. Information on baseline characteristics, vital status at discharge, duration of hospitalization, and up to five secondary discharge diagnoses was collected. Comorbidity was evaluated using the Charlson comorbidity index (CCI). During the observation period (2013-2014), 20,056 patients with asthma acute exacerbation were hospitalized. Median length of hospitalization was 7.9days (interquartile range 4-10) and mean in-hospital mortality was 0.8%. In-hospital mortality and length of hospitalization varied among different regions (from 0 to 2.9% and from 6.5 to 8.9days, respectively). Old age, invasive and non-invasive mechanical ventilation, and CCI resulted as significantly associated with higher in-hospital mortality. Our study results, on a large sample of patients, confirm that hospitalization for asthma acute exacerbation is not uncommon among Italian current population. Older age, high CCI, and use of ventilator support were associated with a higher mortality rate. These findings should be analyzed to set up appropriate health care policies on patients with asthma.

The prevalence and assessment of pain and dyspnoea in acute exacerbations of COPD: A systematic review.

BackgroundDyspnoea and pain are symptoms of chronic obstructive pulmonary disease (COPD). This review focused upon pain and dyspnoea during hospital admissions for acute exacerbations of COPD (AECOPD), with the aim of examining prevalence, assessment, clinical associations, and researcher-reported implications of these symptoms.MethodsFour electronic databases were searched from inception to 31 May 2021. Full text versions of studies were assessed for methodological quality and data were extracted independently by two reviewers. Where data permitted, pooled prevalence of pain and dyspnoea were calculated by meta-analysis.ResultsFour studies were included. The pooled prevalence of pain and dyspnoea was 44% (95% confidence interval (CI) 35%–52%) and 91% (95% CI 87%–94%) respectively. An array of instruments with varying focal periods were reported (pain: six tools, dyspnoea: four tools). Associations and clinical implications between the two symptoms at the time of hospital admission were rarely reported.ConclusionsFew studies reported prevalence of pain and dyspnoea during an AECOPD. A greater understanding into the prevalence, intensity and associations of these symptoms during AECOPD could be furthered by use of standardised assessment tools with clearly defined focal periods.

Adherence with controller medication in adults with asthma – impact of hospital admission for acute exacerbation

Objective Uncontrolled asthma is associated with higher risk of hospital admissions and death. Low adherence to inhaled corticosteroid (ICS), the cornerstone of asthma therapy, is well-documented. Our aim was to investigate if hospital admission with an acute exacerbation of asthma changes ICS adherence. Methods This retrospective cohort study comprises 241 patients hospitalized with an asthma exacerbation over 12 months (May 2019–April 2020). The primary outcome was proportion of ICS adherent patients, defined as Medication Possession Ratio (MPR) ≥80%, in the six-month period before and after admission. Results The pre- to post-admission proportion of ICS adherent patients increased from 10% to 13% (p = 0.25) and the mean ICS MPR increased from 34% to 42% (p < 0.001). Different patterns of post-discharge adherence were observed, as adherent patients remained adherent, while patients with poor pre-admission adherence increased their adherence during two months after discharge followed by a decline in MPR. Co-variates such as sex, age, body mass index (BMI), GINA 2020-treatment step did not predict improvement in adherence after discharge. Conclusions Admission with an asthma exacerbation did not increase the proportion of patients adherent with controller medication, primarily ICS. Although an improvement in adherence was initially seen primarily in previously poorly adherent patients, this increase was transient as it decreased over time post-discharge.

Magnesium Administration For COPD Exacerbation: A Systematic Review and Meta-analysis

BACKGROUND The role of magnesium in patients with acute chronic obstructive pulmonary disease (COPD) exacerbation remains to be determined. AIM We aim to explore the effect of magnesium on COPD exacerbation, as well as its impact on pulmonary function tests and on hospital admissions for acute exacerbation in the emergency department. METHODS This is a systematic review and meta-analysis that included a search of the keywords "magnesium" and "COPD" on PubMed, Google Scholar, Cochrane databases, and Gray literature (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform) from 1963 to May 2021. RESULTS The use of IV magnesium reduced the risk ratio for admission RR= 0.85 (95% CI 0.62 to 1.17). The combined risk ratio for admission increased to 0.95 when we added nebulised magnesium sulphate (95% CI 0.85 to 1.07), p&gt;0.05. The mean score for improvement after IV magnesium was higher (M=16.75, SD=5.11) than the mean score before its administration (M=8.74, SD=8.85), t(4)=-2.57, p=0.031. Thus, the use of IV magnesium sulphate results in a 91.64% improvement in the pulmonary function test. CONCLUSION IV magnesium sulphate improves the pulmonary function test of patients with acute COPD exacerbation in the ED, and possibly reduces the admission rate.

A Case Report of Silicosis: Culprit of Progressive Massive Fibrosis

Silicosis is a fibronodular lung disease secondary to the inhalation of crystalline silica dust. It had continued to cause significant morbidity and mortality worldwide. Here is a case of a 63-year-old woman, a lifelong non-smoker who complained of intermittent wheezing since retired 8 years ago. She had worked in the clay and piping industry for more than a decade. She wore only a simple 3-ply face mask at work without other protective devices. She had multiple hospital admissions for acute exacerbation of chronic lung disease for the past several years. Respiratory examinations revealed bilateral fine crepitations and occasional rhonchi on auscultation. Chest radiograph revealed ground glass changes. Pulmonary function testing showed an irreversible severe obstruction picture with an FEV1 of 45%. High resolution computed tomography thorax demonstrated hyperinflated lungs with emphysematous changes and multiple nodules over subpleural region, conglomerate mass with calcifications over bilateral lungs. Her imaging findings combined with a significant occupational history were suggestive of progressive massive fibrosis (PMF) due to silicosis. She is currently being treated with several inhalers and does not require home oxygen therapy. She is suffering from accelerated silicosis which may potentially progress to radiological deterioration, altered respiratory function and premature death. Therefore, it is essential to avoid any potential hazards that may predispose to silicosis.

Prevalence and associated factors of dysglycemia among patients with chronic obstructive pulmonary disease.

ObjectivesDysglycemia is known to be a common comorbidity of chronic obstructive pulmonary disease (COPD). However, undiagnosed dysglycemia and the associated factors remain under-reported. This study aimed to determine the prevalence and the associated factors of dysglycemia among COPD patients.MethodsThis was a cross-sectional, single-center study involving adults with established COPD (n = 186) divided into those with or without hospital admissions for acute exacerbation. Oral glucose tolerance test (OGTT) was performed in patients with no known history of dysglycemia.ResultsThere were 16 patients who had overt diabetes, and 32 had prediabetes following the OGTT. Forty percent had histories of hospital admissions for COPD exacerbations. Both groups demonstrated similar 2-h post prandial glucose, glycated hemoglobin (HbA1c) and fasting blood glucose. The incidences of newly diagnosed dysglycemia were higher in both groups (40.8% vs 34.6%, p = 0.57). Cumulative days of admission (≥6 days/year) and weight (≥65 kg) were identified as predictors for dysglycemia within the study population.DiscussionThis study demonstrated a high number of overt and newly diagnosed dysglycemia among COPD patients who had no previous history of abnormal glucose. Recent acute exacerbations of COPD could have a negative impact on glycemia, although the results did not attain statistical significance. However, there is a need for adequate screening for dysglycemia, particularly among those with frequent acute exacerbations of their condition.

Association of change in air quality with hospital admission for acute exacerbation of chronic obstructive pulmonary disease in Guangdong, China: A province-wide ecological study

AimsTo assess possible effect of air quality improvements, we investigated the temporal change in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) associated with pollutant concentrations. MethodsWe collected daily concentrations of particulate matter (i.e., PM2.5, PM10 and PMcoarse), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and admissions for AECOPD for 21 cities in Guangdong from 2013 to 2017. We examined the association of air pollution with AECOPD admissions using two-stage time-series analysis, and estimated the annual attributable fractions, numbers, and direct hospitalization costs of AECOPD admissions with principal component analysis. ResultsFrom 2013–2017, mean daily concentrations of SO2, PM10 and PM2.5 declined by nearly 40%, 30%, and 26% respectively. As the average daily 8 h O3 concentration increased considerably, the number of days exceeding WHO target (i.e.,100 μg/m³) increased from 103 in 2015–152 in 2017. For each interquartile range increase in pollutant concentration, the relative risks of AECOPD admission at lag 0–3 were 1.093 (95% CI 1.06–1.13) for PM2.5, 1.092 (95% CI 1.08–1.11) for O3, and 1.092 (95% CI 1.05–1.14) for SO2. Attributable fractions of AECOPD admission advanced by air pollution declined from 9.5% in 2013 to 4.9% in 2016, then increased to 6.0% in 2017. A similar declining trend was observed for direct AECOPD hospitalization costs. ConclusionDeclined attributable hospital admissions for AECOPD may be associated with the reduction in concentrations of PM2.5, PM10 and SO2 in Guangdong, while O3 has emerged as an important risk factor.Summarizes the main finding of the work：Reduction in PM may result in declined attributable hospitalizations for AECOPD, while O3 has emerged as an important risk factor following an intervention.

Significant reduction in hospital admissions for acute exacerbation of chronic obstructive pulmonary disease in Hong Kong during coronavirus disease 2019 pandemic

BackgroundChronic respiratory diseases are risk factors for severe disease in coronavirus disease 2019 (COVID-19). Respiratory tract infection is one of the commonest causes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There has not been evidence suggesting the link between COVID-19 and AECOPD, especially in places with dramatic responses in infection control with universal masking and aggressive social distancing. MethodsThis is a retrospective study to assess the number of admissions of AECOPD in the first three months of 2020 in Queen Mary Hospital with reference to the admissions in past five years. Log-linear model was used for statistical inference of covariates, including percentage of masking, air quality health index and air temperature. ResultsThe number of admissions for AECOPD significantly decreased by 44.0% (95% CI 36.4%–52.8%, p < 0.001) in the first three months of 2020 compared with the monthly average admission in 2015–2019. Compare to same period of previous years, AECOPD decreased by 1.0% with each percent of increased masking (p < 0.001) and decreased by 3.0% with increase in 1 °C in temperature (p = 0.045). The numbers of admissions for control diagnoses (heart failure, intestinal obstruction and iron deficiency anaemia) in the same period in 2020 were not reduced. ConclusionsThe number of admissions for AECOPD decreased in first three months of 2020, compared with previous years. This was observed with increased masking percentage and social distancing in Hong Kong. We postulated universal masking and social distancing during COVID-19 pandemics both contributed in preventing respiratory tract infections hence AECOPD.

P132 Performance of a severity score in risk stratification of patients with ulcerative colitis

Abstract Background Patient stratification according to the risk of developing complications is an essential step to define the best treatment approach in patients with ulcerative colitis (UC). Recently, Siegel et al (Gut 2017) published a score that aims to access the disease severity, considering disease activity (both clinical and endoscopic factors) and complications during the disease course, ranging from 0 to 100 values (higher values indicating worse disease severity). Our goal was to evaluate the capacity of this score calculated at the time of diagnosis (dx) to predict disease course during follow-up (FU): steroid use, therapy escalation to immunomodulators or biologics, hospitalisation and/or abdominal surgery. Methods Retrospective cohort study including incident cases of UC in our centre between December 2012 and December 2018. We calculated the score at the time of dx and at the end of FU and collected data about disease course. Results Eighty-five patients (57% men with a mean age of 43 ± 17 years) with newly diagnosed UC were included. Disease extension according to Montreal was E1 in 30/85 patients, E2 in 37/85 patients and E3 in 18/85 patients. Median FU time was 40 months. Median risk score at the time of dx was 30 (IQR 3–91) and it was higher in patients with younger age (36 vs. 26, p = 0.08) and extensive colitis (64 vs. 26, p &amp;lt; 0.001). During FU, 19/85 and 17/85 patients needed steroid use and therapy escalation, respectively. Proximal disease extension occurred in one patient. Hospital admission for acute exacerbation and/or colectomy was required in 6/85. The score at dx was higher in patients who underwent hospital admission or colectomy (score: 70 vs. 26, p = 0.002), or that needed steroid (score: 57 vs. 26, p &amp;lt; 0.001) or therapy escalation (score: 57 vs. 26, p &amp;lt; 0.001) during FU. In a survival analysis, the time for steroid use (plogrank &amp;lt; 0.001) or therapy escalation (plogrank &amp;lt; 0.001) was lower in patients with a higher score at dx (61 vs. 88 months and 56 vs. 86 months, respectively). The median score at the end of FU was 3 (IQR 0–66); a second colonoscopy was not available in three patients, who were not included in this analysis. There was a score reduction in 77/82 patients (39/82 had a score of 0). Only one patient had a similar score and 4/85 patients had a higher score. Patients with a significant score reduction during FU (below the median) were more frequently patients with no need for steroid use (p &amp;lt; 0.001) or therapy escalation (p = 0.002). Conclusion This severity score seems to be a promising tool for risk stratification and prognosis determination in patients with UC, and its utility should be validated in prospective studies.

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD: An Historical Cohort Study Using Electronic Health Records

In previous systematic reviews (predominantly of randomized controlled trials), pulmonary rehabilitation (PR) has been shown to reduce hospital admissions for acute exacerbations of COPD (AECOPD). However, findings have been less consistent for cohortstudies. The goal of this study was to compare rates of hospitalized and general practice (GP)-treated AECOPD prior to and following PR. Using anonymized data from the Clinical Practice Research Datalink and Hospital Episode Statistics, hospital admissions and GP visits for AECOPD were compared 1 year prior to and 1 year following PR in patients referred for PR. Exacerbation rates were also compared between individuals eligible and referred for PR vsthose eligible and not referred. A total of 69,089 (64%) of the patients with COPD in the cohort were eligible for PR. Of these, only 6,436 (9.3%) were recorded as having been referred for rehabilitation. A total of 62,019 (89.8%) were not referred, and 634 (0.98%) declined referral. When combining GP and hospital exacerbations, patients who were eligible and referred for PR had a slightly higher but not statistically significant exacerbation rate (2.83 exacerbations/patient-year; 95%CI, 2.66-3.00) than those who were eligible but not referred (2.17 exacerbations/patient-year; 95%CI, 2.11-2.24). This study found that< 10%of patients who were eligible for PR were actually referred. Patients who were eligible and referred for (but not necessarily completed) PR did not have fewer GP visits and hospitalizations for AECOPD in the year following PR compared with those not referred or compared with the year prior to PR.

Fine particulate matter on hospital admissions for acute exacerbation of chronic obstructive pulmonary disease in southwestern Taiwan during 2006–2012

This study explored the effects of PM2.5 on hospital admissions (HAs) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in southwestern Taiwan. Data on HAs for AECOPD, pollutants, and meteorological variables were obtained from the National Health Insurance Research Database and Environmental Protection Administration. The relative risks (RRs) of HAs for AECOPD was estimated using the Quasi-Poisson generalized additive model. A total of 38,715 HAs for AECOPD were recorded. The average daily HAs for AECOPD and mean 24-h average level of PM2.5 were 15.2 and 38.8 µg/m3, respectively. For both single and multiple pollutant (adjusted for O3 and NO2) models, increased AECOPD admissions were significantly associated with PM2.5 during cold season, with the RRs for every 10 µg/m3 increase in PM2.5 being 1.02 (95% CI = 1.007–1.040) at lag 0–1 in single-pollutant, and 1.02 (95 % CI = 1.001–1.042) at lag 0 day in multiple pollutant model. People 65 years of age and older had higher risk of HAs for AECOPD after PM2.5 exposure. The RRs of PM2.5 on HAs for AECOPD were robust after adjusting for O3 and NO2. Findings reveal an association between PM2.5 and HAs for AECOPD in southwestern Taiwan, particularly during cold season.

Overview of the pharmacological challenges facing physicians in the management of patients with concomitant cardiovascular disease and chronic obstructive pulmonary disease.

Cardiovascular disease (CVD), including ischaemic heart disease (IHD) and heart failure (HF), and chronic obstructive pulmonary disease (COPD) are often concomitant because they share both risk factors (smoke) and pathological pathways (systemic inflammation). Cardiovascular disease and COPD association is increasing overtime. Several registries clearly showed a negative impact on the clinical outcome of the concomitant presence of CVD and COPD. Patients with CVD and COPD present an increased risk for myocardial infarction, HF, and hospital admission for acute exacerbation of COPD, with a negative impact on prognosis. To reduce the effect of this negative association, it is of paramount importance the pharmacological treatment with both cardiovascular and respiratory drugs, according to current guidelines. Nevertheless, several registries and studies showed that evidence-based drugs (both cardiovascular and respiratory) are often under administered in this subset of patients. In this overview, we summarize the available data regarding the use of cardiovascular drugs (antiplatelet agents, angiotensin converting enzyme inhibitors, β-blockers, and statins) in COPD patients, with or without concomitant IHD. Furthermore, we report advantages and disadvantages of respiratory drugs (β2 agonists, anti-cholinergics, and corticosteroids) administration in COPD patients with CVD.

An observational study of PM10 and hospital admissions for acute exacerbations of chronic respiratory disease in Tasmania, Australia 1992–2002

ObjectiveParticulate matter with a diameter below 10 µ (PM10) has been a major concern in the Tamar Valley, Launceston, where wood heaters are extensively used. We examined the relationship between...

Factors Influencing the Length of Hospital Stay in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease Admitted to Intensive Care Units

The cost of hospital admissions for acute exacerbations of COPD (AECOPD) accounts for 70% of total costs for the treatment of COPD patients. We wanted to identify clinical parameters associated with a longer length of stay (LOS) in these patients. We reviewed electronic medical records of patients with AECOPD admitted between January 1, 2006, and December 31, 2010. The inclusion criteria were age 45 years or older, the diagnosis of AECOPD by GOLD (Global Initiative for Chronic Obstructive Lung Disease) guideline criteria, and admission to an intensive care unit. We compared the quartile with the longest LOS group with the other 3 quartiles using routine clinical data. 217 patients met inclusion criteria. The mean age was 67.4 ± 10.9 years, 47% were male, the mean FEV1s (forced expiratory volume in 1 second) was 42.4% ± 17.4% of predicted, and the mean LOS was 9.0 ± 6.0 days. Univariate analysis demonstrated that nursing home status, low albumins, the presence of pleural effusions, intubation, and high APACHE II scores were associated with increased LOS (P < .05 for each factor). Multivariate logistic regression demonstrated that the need for intubation (P < .001) predicted an increased LOS. Our study demonstrates that intubation for mechanical ventilation increased the LOS in patients with AECOPD. More intensive interventions in these patients might decrease the LOS and improve outcomes.

Description of Hospital Admissions for Acute Exacerbation of COPD

Background: Chronic obstructive pulmonary disease (COPD) affects 9.1% of the population aged 40-69 in Spain, with wide geographic variation. Acute exacerbations of COPD (AECOPD) are a frequent cause of hospital admission, significantly increasing healthcare costs and affecting the quality of life of patients. Patient characteristics and treatment procedures differ across geographic areas, even across hospitals in the same country. Objective: To analyze epidemiological and clinical factors associated with hospital admissions for AECOPD in our health area. Methods: Retrospective study reviewing the medical records of all patients admitted for AECOPD in the Hospital Complex of Santiago de Compostela, between 2007 and 2008. Data are expressed as mean (±standard deviation) or median (interquartile range) values for continuous variables and as frequencies or percentages for categorical variables. Chi-square was used to compare proportions, and Student’s t-test for mean values (Mann-Whitney’s U-test for variables on non-normal distributions).Data analysis was performed with SPSS 15. Results: We registered 1403 admissions for AECOPD of 757 patients, predominantly male (77% of cases), elderly (60% aged above 75), with moderate to severe forms of the disease, as 56.4% of patients were either in GOLD stage II or III. Smoking history was included in the records of 475 patients (63%), 30% of patients which were active smokers. Charlson index was above 2 in 64% of cases. The most common symptom was dyspnea. Hospital admissions were more common in the winter season. The average stay in the period under study was 12.3 days. 3.6% required admission to the ICU. 6% of patients were readmitted early and 4.8% died during hospitalization. As for baseline therapy, it notably included anticholinergics for 62% and inhaled corticosteroids (ICS) for 60% of patients. 26% followed home oxygen therapy. Smoking cessation care provision took place in 7.9% of cases. Conclusions: AECOPD patients in our health area are mainly elderly males. Their overall health is not good, with significant comorbidity. The average stay is long. 4.8% die during hospitalization. 5.8% are readmitted within 15 days. 26% follow home oxygen therapy, but this indication is questionable in one in four cases. Smoking cessation care provision during hospitalization should be significantly improved.

P118 Post discharge pulmonary rehabilitation for acute exacerbation COPD does not always reduce re-admission rates

IntroductionPost-discharge pulmonary rehabilitation (PR) within 7–10 days after discharge from hospital admission for acute exacerbation of COPD (AECOPD) has been shown not only to result in the well-described benefits of...

Trends in hospital admissions for acute exacerbation of COPD in Spain from 2006 to 2010

We aim to analyze changes in incidence, comorbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) over a 5-year study period in Spain. We selected all hospital admissions for AE-COPD between 2006 and 2010 from the National Hospital Discharge Database covering the entire population of Spain. We identified a total of 215,835 patients. Overall crude incidence had decreased from 2.9 to 2.4 exacerbations of COPD per 10,000 inhabitants from 2006 to 2010 (p < 0.001). In 2006, 17.9% of patients had a Charlson Index >2 and in 2010, the prevalence had increased to 25.0% (p < 0.001). Regarding to treatment, we detected a significant increase in the use of non-invasive ventilation from 2.1% in 2006 to 5.3% in 2010 (p < 0.001). The median LOHS was 7 days in 2006 and it remained stable until 2010. During the period studied, the mean cost per patient increased from 3747 to 4129 Euros. Multivariate analysis showed that incidence of hospitalizations for AE-COPD and IHM had significantly decreased from 2006 to 2010. The current study provides data indicating a decrease in incidence of hospital admissions for AE-COPD in Spain from 2006 to 2010 with concomitant reduction in IHM, despite increasing comorbidity during this period, with no variations in LOHS. The mean cost per patient has risen significantly.