Hospital Admissions For Acute Exacerbations Of COPD Research Articles

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.

Body composition and micronutrient deficiencies in patients with an acute exacerbation of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a multisystem disorder. Abnormal body composition (BC) and micronutrient deficiencies (MD) contribute significantly to morbidity associated with acute exacerbations of COPD (AECOPD). COPD is a major health problem in Western Sydney. To study the pattern of BC and MD in patients admitted with an AECOPD to Western Sydney. The BC and serum levels of selected micronutrients were recorded in prospective, consecutive patients admitted to hospital with AECOPD in Western Sydney. A total of 94 patients was enrolled, 43% female, and the average age was 69.8 ± 8.2 years (SD). Admission spirometry revealed a mean spirometric ratio of 0.42 ± 0.14 (SD) and a severely reduced mean percentage FEV1 of predicted at 29.1% ± 11.6 (SD). A total of 51% of the population was overweight or obese, with an average body mass index of 25.9 ± 7.7 kg/m2 (SD). When fat-free mass (FFM) was also considered 23% were cachectic, 9% had muscle atrophy and 6% were semi-starved. Vitamin D deficiency (<50 nmol/L) was present in 53% and vitamin B12 deficiency (<222 pmol/L) was present in 31%. Anaemia was present in 30%, with 38% of these being iron deficient. Living status (alone or with family) was not associated with BC or micronutrient deficiencies (MD). Patients with ≥2 hospital admissions for AECOPD had a significantly lower mean B12 level (280.5 ± 143.0 pmol/L (SD) vs 360.5 ± 198.1 pmol/L (SD) P = 0.042). The malnutrition screening tool, a questionnaire-based assessment of malnutrition used by the local health area did not accurately predict patients with abnormal BC or those with >2 MD. In patients admitted with AECOPD, the majority of subjects were overweight or obese, with a low FFM. MD, in particular B12 and vitamin D, were common. Interventional studies addressing BC and MD are required to assess potential improvements in AECOPD-related morbidity and mortality.

Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012.

Hospitalizations are not isolated events in COPD patients. A significant percentage of patients are readmitted during the first month after their discharge. The aim of this study was to elucidate changes in the incidence, comorbidity, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients readmitted following an initial hospitalization by acute exacerbation of COPD (AE-COPD). We selected all patients ≥40 years, hospitalized for AE-COPD between 2006 and 2012 in Spain using the National Hospital Discharge Database. Patient readmissions were defined as inpatient re-hospitalization within 30 days of discharge for AE-COPD. We identified 301 794 discharges of patients having hospital admissions for AE-COPD as their primary diagnosis (82.47% first admissions, 17.53% hospital readmissions). The risk of re-hospitalization was higher in patients aged 65 to 84 years, males, with comorbidities, malnutrition, not obese, respiratory acidosis, treated with non-invasive ventilation (NIV) or discharged to a health/social institutions. Factors associated with IHM among patients readmitted were: older age, increased Charlson Index, malnutrition, not being obese, respiratory acidosis and treatment with NIV. The IHM and hospital costs were significantly higher in readmissions compared with first admissions. We observed that the incidence and mortality of readmissions had significantly decreased from 2006 to 2012. Hospital readmissions within 30 days of discharge for AE-COPD are common in Spain. They have a high impact for COPD patients and health system. However, we have found a downward trend in incidence and mortality of readmissions from 2006 to 2012.

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.

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.