Hospital Admission For COPD Exacerbation Research Articles

How Accurate Is the Diagnosis of "Chronic Obstructive Pulmonary Disease" in Patients Hospitalized with an Acute Exacerbation?

Rationale: COPD diagnosis requires relevant symptoms and an FEV1/FVC ratio of <0.7 post-bronchodilator on spirometry. Patients are frequently labeled as COPD based on clinical presentation and admitted to the hospital with this diagnosis even though spirometry is either not available or has never been performed. The aim of this study was to evaluate the accuracy of COPD diagnosis based on post-bronchodilator spirometry, following hospital admission for COPD exacerbation. Methods: This is a retrospective study with a cross-sectional analysis of a subgroup of patients. Demographic and clinical data and pre-admission spirometry were collected from electronic records of patients hospitalized with a primary diagnosis of COPD. Patients without available spirometry were contacted for a pulmonary consultation and spirometry. Three groups were compared: patients with a confirmed COPD diagnosis (FEV1/FVC < 0.7), without COPD (FEV1/FVC > 0.7), and those who have never performed spirometry. Results: A total of 1138 patients with a recorded diagnosis of COPD were identified of which 233 patients were included in the analysis. Only 44.6% of patients had confirmed COPD according to GOLD criteria. In total, 32.6% of the patients had never undergone spirometry but were treated as COPD, and 22.7% had performed spirometry without evidence of COPD. Recurrent admission due to COPD was a strong predictor of a confirmed COPD diagnosis. Conclusions: Among the patients admitted to the hospital with a COPD diagnosis, a high proportion were not confirmed by the current GOLD report or had never performed spirometry. Stricter implementation of the diagnostic criteria of COPD in admitted patients is necessary to improve diagnosis and the treatment outcomes in these patients.

Blood eosinophils on hospital admission for COPD exacerbation do not predict the recurrence of moderate and severe relapses.

Background and objectiveThe relationship between hospitalisation with an eosinophilic acute exacerbation of COPD (AE-COPD) and future relapses is unclear. We aimed to explore this association by following 152 patients for 12 months after hospital discharge or until their first moderate or severe flare-up.MethodsPatients hospitalised with AE-COPD were divided into eosinophilic and non-eosinophilic groups based on full blood count results on admission. All patients were treated with a course of systemic corticosteroid. The Cox proportional hazards model was used to study the association with the time to first re-exacerbation; a generalised linear regression model was applied to identify clinical variables related to the recurrence of relapses.ResultsWe did not find a difference in the time to the next moderate or severe exacerbation between the eosinophilic (≥2% of total leukocytes and/or ≥200 eosinophils·µL−1, n=51, median (interquartile range): 21 (10–36) weeks) and non-eosinophilic groups (n=101, 17 (9–36) weeks, log-rank test: p=0.63). No association was found when other cut-off values (≥3% of total leukocytes and/or ≥300 eosinophils·µL−1) were used for the eosinophilic phenotype. However, the higher number of past severe exacerbations, a lower forced expiratory volume in 1 s (FEV1) at discharge and higher pack-years were related to shorter exacerbation-free time. According to a subgroup analysis (n=73), 48.1% of patients with initial eosinophilic exacerbations had non-eosinophilic relapses on readmission.ConclusionsOur data do not support an increased risk of earlier recurring moderate or severe relapses in patients hospitalised with eosinophilic exacerbations of COPD. Eosinophilic severe exacerbations present a variable phenotype.

Hospitalization for COPD Exacerbation: An Opportunity for Azithromycin?

Hospital admission for COPD exacerbation is a frequent and costly event. Although preventing hospitalization is a key goal for patients and healthcare systems, the hospital admission represents an opportunity to optimize care. Daily azithromycin therapy has been shown to reduce COPD exacerbations, yet this therapy remains underutilized amid concerns for cardiac toxicity. We sought to evaluate the potential impact of initiating chronic azithromycin in appropriate patients during hospitalization for COPD exacerbation. We reviewed medical records from 808 patients admitted with COPD exacerbation who were currently receiving optimal inhaler therapy. To determine the potential impact of initiating azithromycin at hospital discharge, we recorded the number of hospital readmissions within the following year. We quantified the proportion of patients who were free of any of the contraindications proffered for chronic azithromycin therapy. Results: Two patients were already receiving chronic azithromycin. Of 806 remaining patients, 51.4% of patients were readmitted to the same hospital within 1 year, and 7.4% had > 5 readmissions. Only 17.5% of the patients did not have any cardiac contraindications to azithromycin therapy and only 7.9% were free of contraindications and non-smokers. With regard to specific risk factors, 10.2% had baseline QTc prolongation, 65% were taking concurrent QTc prolonging medications, 32.8% had comorbid cardiovascular disease and 13.4% had a resting heart rate > 100 beats per minute. Conclusion: Patients hospitalized for COPD exacerbation have a high rate of readmission within the following year, and could potentially benefit from the exacerbation-reduction effects of chronic azithromycin therapy. Unfortunately, an intervention designed to promote azithromycin initiation is likely to be low-yield, because the majority of hospitalized patients in our sample had a contraindication predisposing them to cardiac toxicity.

Hospital Admission for COPD Exacerbation: An Opportunity for Azithromycin?

SESSION TITLE: COPD Posters I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Hospitalization for COPD exacerbation is most common among patients with the “frequent exacerbator” phenotype. Hospital admission for COPD exacerbation is frequent in the U.S., with 606,000 admissions in 2010 and 21% of these patients will experience readmission within 30-days. Although preventing hospitalization is a key goal for patients and healthcare systems, the hospital admission represents an opportunity to optimize care. Good evidence supports the effectiveness of daily azithromycin therapy for reducing COPD exacerbations, yet this therapy remains underutilized amid concerns for cardiac toxicity. We sought to evaluate the potential impact of an intervention designed to promote the use of chronic azithromycin in appropriate patients during hospitalization for COPD exacerbation. METHODS: We reviewed medical records from 253 patients admitted to Tampa General Hospital in Tampa, FL with a primary diagnosis of COPD exacerbation. We extracted data to evaluate how many patients were receiving chronic azithromycin and to determine if the patients met any contraindications for azithromycin therapy. We also recorded smoking status and the number of hospital readmissions within the following year. RESULTS: 2 patients (0.008%) were excluded because they were already receiving chronic azithromycin. Of 251 remaining patients, 39% were female, and the average age was 62.3 years. 49.8% were current smokers. 52.6% of patients were readmitted to the same hospital within 1 year, and almost 10% had > 5 readmissions. Only 23.9% of the patients had no contraindication to azithromycin therapy. With regard to specific contraindications, 10% had QTc prolongation, 53% were taking concurrent QT prolonging medications, 33.5% had underlying coronary artery disease or cardiomyopathy and 13.2% had a resting heart rate > 100 beats per minute. CONCLUSIONS: Consistent with other reports, we found the use of chronic azithromycin therapy to be very uncommon among patients hospitalized for COPD exacerbation. Over three-quarters of the patients in our sample were not appropriate candidates for azithromycin therapy due to risk factors for cardiovascular toxicity. CLINICAL IMPLICATIONS: Patients hospitalized for COPD exacerbation are likely to be “frequent exacerbators”, and could potentially benefit from chronic azithromycin. However, an intervention designed to promote azithromycin initiation may be low-yield, because the majority of hospitalized patients in our sample had a contraindication predisposing them to cardiac toxicity. DISCLOSURE: The following authors have nothing to disclose: Nidhi Patel, Stephanie Taylor, Shan Cheng, Allen Brown, David DiNuoscio, Brice Taylor No Product/Research Disclosure Information

Predictive Model of Hospital Admission for COPD Exacerbation.

The objective of this work was to determine predictive factors of hospital admission for exacerbation during primary care visits in patients with COPD. A retrospective cohort study was undertaken to assess risk of hospital admission for COPD exacerbation in primary care patients from November 1, 2010 to October 31, 2013. Data sources were primary care electronic medical records and the hospital discharge minimum data set. A total of 2,501 subjects >40 y of age with a spirometry-based COPD diagnosis were included and followed up for 3 y. The dependent variable was hospital admission for exacerbation; independent variables were: clinical parameters, spirometry results, and severity of disease (according to Global Initiative for Chronic Obstructive Lung Disease criteria). The association of these variables with hospital admission was analyzed with the adjusted odds ratio using a logistic regression model. Mean age of subjects at the beginning of the study was 68.4 y (SD = 11.6), and 75% were men. Severity was mild in 50.8% of subjects, moderate in 35.3%, severe in 9.4%, and very severe in 4.4%. After 3 y, 32.5% of subjects had been admitted for exacerbation. Predictive values for hospital admission were: age, sex, previous exacerbations, number of visits to the primary care center, comorbidities, smoking, severity (Global Initiative for Chronic Obstructive Lung Disease), and influenza immunization. The area under the receiving operator characteristic curve was 0.72. This model can identify patients at high risk of hospital admission for COPD exacerbation in our setting. Further studies are needed to validate the model in different populations and settings.

P247 Impact of Implementing COPD Self Management Plans & Rescue Medications Across 3 Hospitals

IntroductionCOPD is the second leading cause of emergency admissions in the UK. National guidelines for managing COPD advise that patients at risk of having or those who have had an...

Randomized Trial of Zileuton for Treatment of COPD Exacerbations Requiring Hospitalization

Rationale: Leukotrienes have been implicated in the pathogenesis of acute exacerbations of COPD, but leukotriene modifiers have not been studied as a possible therapy for exacerbations. Objective: We sought to test the safety and efficacy of adding oral zileuton (a 5-lipoxygenase inhibitor) to usual treatment for acute exacerbations of COPD requiring hospitalization. Methods: Randomized double-blind, placebo-controlled, parallel group study of zileuton 600 mg orally, 4 times daily versus placebo for 14 days starting within 12 hours of hospital admission for COPD exacerbation. Primary outcome measure was hospital length of stay; secondary outcomes included treatment failure and biomarkers of leukotriene production. Main Findings: Sixty subjects were randomized to zileuton and 59 to placebo (the study was stopped short of enrollment goals because of slow recruitment). There was no difference in hospital length of stay (3.75 ± 2.19 vs. 3.86 ± 3.06 days for zileuton vs. placebo, p = 0.39) or treatment failure (23% vs. 27% for zileuton vs. placebo, p = 0.63) despite a decline in urinary LTE4 levels in the zileuton-treated group as compared to placebo at 24 hours (change in natural log-transformed ng/mg creatinine −1.38 ± 1.19 vs. 0.14 ± 1.51, p < 0.0001) and 72 hours (−1.32 ± 2.08 vs. 0.26 ± 1.93, p<0.006). Adverse events were similar in both groups. Principal Conclusions: While oral zileuton during COPD exacerbations that require hospital admission is safe and reduces urinary LTE4 levels, we found no evidence suggesting that this intervention shortened hospital stay, with the limitation that our sample size may have been insufficient to detect a modest but potentially meaningful clinical improvement.