Hospital Admissions For Chronic Obstructive Pulmonary Disease Research Articles

C reactive protein and chronic obstructive pulmonary disease: a Mendelian randomisation approach

BackgroundIt is unclear whether elevated plasma C reactive protein (CRP) is causally related to chronic obstructive pulmonary disease (COPD). The authors tested the hypothesis that genetically elevated plasma CRP causes...

Chronic Obstructive Pulmonary Disease and Long-Term Exposure to Traffic-related Air Pollution

Short-term exposure to air pollution has been associated with exacerbation of chronic obstructive pulmonary disease (COPD), whereas the role of long-term exposures on the development of COPD is not yet fully understood. We assessed the effect of exposure to traffic-related air pollution over 35 years on the incidence of COPD in a prospective cohort study. We followed 57,053 participants in the Danish Diet, Cancer, and Health cohort in the Hospital Discharge Register for their first hospital admission for COPD between 1993 and 2006. We estimated the annual mean levels of nitrogen dioxide (NO₂) and nitrogen oxides (NO(x)) at all residential addresses of the cohort participants since 1971 to an event or 2006 and used indicators of traffic near the residential address at recruitment. We assessed the association between exposure to air pollution and COPD incidence by Cox regression analyses for the full cohort, and for participants with and without comorbid conditions, including asthma, diabetes, or cardiovascular disease. A first hospital admission for COPD was recorded for 1,786 (3.4%) of 52,799 eligible subjects between recruitment (1993-1997) and 2006. COPD incidence was associated with the 35-year mean NO₂ level (hazard ratio, 1.08; 95% confidence interval, 1.02-1.14, per interquartile range of 5.8 μg/m³), with stronger associations in subjects with diabetes (1.29; 1.05-1.50) and asthma (1.19; 1.03-1.38). Long-term exposure to traffic-related air pollution may contribute to the development of COPD with possibly enhanced susceptibility in people with diabetes and asthma.

Hospital admissions for asthma, diabetes and COPD: is there an association with practice nurse staffing? A cross sectional study using routinely collected data

BackgroundDelivering good quality primary care for patients with chronic conditions has the potential to reduce non-elective hospital admissions. Practice nurse staffing levels in England have been linked to attainment of general practice performance targets for some chronic conditions. The aim of this study was to examine whether practice nurse staffing level is similarly associated with non-elective hospital admissions in three clinical areas: asthma, Chronic Obstructive Pulmonary Disease (COPD) and diabetes.MethodsThis observational study used cross sectional analysis of routinely collected data. Hospital admissions data for the period 2005-2006 (for asthma, COPD and diabetes) were linked with a database of practice characteristics, nurse staffing data and data on population characteristics for the same period. Statistical modelling explored the relationship between non-elective hospital admission rates for the three conditions and the list size per full time equivalent (FTE) practice nurse.ResultsHigher practice nurse staffing levels were significantly associated with lower rates of admission for asthma (p < 0.001) and COPD (p < 0.001). A similar association was seen for patients with two or more admissions (p < 0.05 for asthma and p < 0.001 for COPD). For diabetes, higher practice nurse staffing level was significantly associated with higher admission rates (p < 0.05), but this association was not significant in case of patients with two or more admissions. Across all models, increasing deprivation was associated with higher admission rates for all conditions.ConclusionsThe inconsistent relationship between nurse staffing and patient outcomes across the different conditions and the fact that for diabetes the relationship between staffing and outcomes was in a different direction from the association between staffing and care quality, highlights the need to avoid making a simple causal interpretation of these findings and reduces the possible confidence in such conclusions. There is a need for more research into the organisation and delivery of diabetes care services in general practice, preferably using patient level data; in order to better understand the impact of the different staffing configurations on patient outcomes.

Genetic influences on chronic obstructive pulmonary disease – A twin study

Genes that contribute to the risk of developing Chronic Obstructive Pulmonary Disease (COPD) have been identified, but an attempt to accurately quantify the total genetic contribution to COPD has to our knowledge never been conducted. Hospital discharge diagnoses data on COPD were analysed in 22,422 Danish twin pairs, 20-71 years of age. The analyses were replicated in a population of 27,668 Swedish twin pairs, 45-108 years of age. A Cox-regression model was applied to the discordant time from the age at first hospital admission for COPD in the co-twin of an affected twin. Latent factor models were used to estimate genetic and environmental effects. The probandwise concordance rate for COPD was higher in monozygotic (MZ) than in dizygotic (DZ) twins, 0.19 vs. 0.07 (p=0.08) in the Danish population, and 0.20 vs. 0.08 (p=0.006) in the Swedish population. After adjusting for sex, smoking and age at first hospital admission the risk of developing COPD in the co-twin of an affected twin was higher in MZ than in DZ twins, with hazards ratio 4.3 (95% confidence interval 1.2-15.8, p=0.03) in Danish twins and 3.4 (1.5-7.7, p=0.004) in Swedish twins. According to the most parsimonious model, additive genetic factors explained 63% (46-77%) of the individual COPD-susceptibility in the Danish population and 61% (48-72%) in the Swedish population. The susceptibility to develop severe COPD, as defined by hospitalizations, is strongly influenced by genetic factors. Approximately 60% of the individual susceptibility can be explained by genetic factors.

Preventing Hospitalization for COPD Exacerbations

Severe chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalization are a major cause of morbidity and mortality. Recognition of the importance of COPD exacerbations has led to the knowledge that prevention of exacerbations and early treatment are important goals of COPD therapy. Preventive management of COPD aiming at reducing exacerbations complicated by hospital admissions includes vaccination, avoiding pollutant exposure, and, when indicated, long-term oxygen therapy. Landmark studies have shown benefits of long-acting inhaled bronchodilators and combined long-acting inhaled bronchodilators with corticosteroids. The combination of a long-acting muscarinic antagonist with a long-acting beta (2) agonist and inhaled corticosteroids offers the best possibility to reduce the risk of exacerbations requiring hospital admissions. Pulmonary rehabilitation in COPD patients at risk of being hospitalized and regular physical activity have been shown to be associated with a lower risk of hospital admissions. Recent advances in the delivery of evidence-based care including a collaborative multicomponent self-management intervention can reduce the risk of COPD hospital admissions. If physicians meet best practice, this will have potential clinical implications, including a reduction of hospitalizations. Novel pharmacological therapy, which can prevent disease progression and exacerbations, is still needed. New self-management strategies such as a written action plan that helps patients recognize their exacerbation and promptly access treatment may have great potential. This needs to be evaluated in a properly designed randomized clinical trial before it becomes the standard of care for COPD patients.

Disease Management Program for Chronic Obstructive Pulmonary Disease

The effect of disease management for chronic obstructive pulmonary disease (COPD) is not well established. To determine whether a simplified disease management program reduces hospital admissions and emergency department (ED) visits due to COPD. We performed a randomized, adjudicator-blinded, controlled, 1-year trial at five Veterans Affairs medical centers of 743 patients with severe COPD and one or more of the following during the previous year: hospital admission or ED visit for COPD, chronic home oxygen use, or course of systemic corticosteroids for COPD. Control group patients received usual care. Intervention group patients received a single 1- to 1.5-hour education session, an action plan for self-treatment of exacerbations, and monthly follow-up calls from a case manager. We determined the combined number of COPD-related hospitalizations and ED visits per patient. Secondary outcomes included hospitalizations and ED visits for all causes, respiratory medication use, mortality, and change in Saint George's Respiratory Questionnaire. After 1 year, the mean cumulative frequency of COPD-related hospitalizations and ED visits was 0.82 per patient in usual care and 0.48 per patient in disease management (difference, 0.34; 95% confidence interval, 0.15-0.52; P < 0.001). Disease management reduced hospitalizations for cardiac or pulmonary conditions other than COPD by 49%, hospitalizations for all causes by 28%, and ED visits for all causes by 27% (P < 0.05 for all). A relatively simple disease management program reduced hospitalizations and ED visits for COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00126776).

New and Controversial Therapies for Chronic Obstructive Pulmonary Disease

There is a medical need in chronic obstructive pulmonary disease (COPD) for novel therapies with improved anti-inflammatory activity and the potential to affect disease progression. The concept of "super bronchodilators" is currently in development. Nonsteroidal antiinflammatory approaches are now being developed and are going under investigation. Restoration of steroid sensitivity is also a potential target in COPD. This could be done by increasing HDAC-2 expression and/or activation, by decreasing p38-kinase or delta-isoform of PI3K. Disease modification that may impact on long-term health status and survival of the patient is the primary and most challenging target for novel therapy in COPD. There is need, however, for new methods and biomarkers to follow disease progression. There has been significant innovation in the nonpharmacological management of COPD including team-based approaches with collaborative self-management. Information and guidelines about self-management, coupled with interventions that provide patients with needed skills to increase their confidence, have potential impact on patient health. Recently, it has been shown that self-management programs reduce the probability of COPD hospital admissions. We should certainly be enthusiastic about these results, but there is need to increase our understanding of the relative effectiveness of specific components and how to best support COPD patients in self-management. Conceptualization of a research plan for COPD self-management is needed for future research to be successful.

Environmental factors and hospitalisation for chronic obstructive pulmonary disease in a rural county of England

Background:Chronic obstructive pulmonary disease (COPD) is a major global cause of morbidity and mortality. Studies in urban areas have shown associations between air pollutants and hospital admissions for COPD. Whether...

Plasma markers of inflammation and incidence of hospitalisations for COPD: results from a population-based cohort study

Background:The relationship between plasma markers of inflammation and the incidence of chronic obstructive pulmonary disease (COPD) is still unclear. This population-based study explored whether raised levels of five inflammation-sensitive plasma...

Effects of Asian Dust Storm Events on Hospital Admissions for Chronic Obstructive Pulmonary Disease in Taipei, Taiwan

In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei city. These occurrences are known as Asian dust storm (ADS) events. These ADS events lead to enhanced PM10 levels over that contributed by the usual local sources. The objective of this study was to assess the possible associations of PM10 with hospital admissions for chronic obstructive pulmonary disease (COPD) in Taipei, Taiwan, during the period 1996–2001. We identified 54 dust storm episodes that were classified as index days. Daily COPD admissions on the index days were compared with admissions on the comparison days. We selected 2 comparison days for each index day, 7 days before the index days and 7 days after the index days. The effects of dust storms on hospital admissions for COPD were prominent 3 days after the event (relative risk = 1.057; 95% confidence interval = 0.982–1.138). However, the association was not statistically significant. There may not have been enough power to detect associations resulting from the inadequate sample size of COPD admissions on ADS events days. However, It seems worthwhile to pay more attention to the ADS events and health in the future.

Respiratory hospital admissions were associated with ambient airborne pollen in Darwin, Australia, 2004–2005

Although the role of pollen and fungus in specific allergic disorders has been well established, the public health impacts of ambient concentrations of airborne pollen and fungal spores; the shapes of concentration-response relationships; and the relative effects of different taxa are gaps in current knowledge. To investigate associations between daily average ambient pollen and fungal spore concentrations with hospital admissions for total respiratory diseases; asthma; chronic obstructive pulmonary disease (COPD); and respiratory infections in Darwin, Australia, during the period from April 2004 to November 2005. We assessed these relationships in a two-stage modelling approach designed to quantify potential non-linear relationships. First, generalized additive models determined the shapes of concentration-response relationships. Second, linear associations were examined using generalized linear models. Non-linear relationships were analysed by categorizing pollen and fungal spore concentrations based on their distributions. Positive linear associations were found between total pollen concentrations and hospital admissions for total respiratory diseases and COPD. While our exploratory first-stage analysis suggested non-linear relationships for total pollen with asthma and respiratory infections, no convincing evidence for these relationships was found in the second-stage analysis. When individual taxa were investigated, associations were the strongest in relation to Myrtaceae pollen (the dominant tree taxa in the region), while positive associations not attaining statistical significance were observed for Poaceae, Cyperaceae and Arecaceae. No associations were evident for any conditions with fungal spores. Our finding of an association between pollen count and respiratory hospital admissions that could not be explained by asthma admissions suggests that ambient airborne pollens might have a wider public health impact than previously recognized.

Air Pollution and Hospital Admissions for Chronic Obstructive Pulmonary Disease in a Subtropical City: Taipei, Taiwan

This study was undertaken to determine whether there was an association between air pollutant levels and hospital admissions for chronic obstructive pulmonary disease (COPD) in Taipei, Taiwan. Hospital admissions for COPD and ambient air pollution data for Taipei were obtained for the period 1996–2003. The relative risk of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant model, on warm days (≥20°C) statistically significant positive associations were found in all pollutants except sulphur dioxide (SO2). However, statistically significant effects for COPD admissions on cool days (<20°C) were observed only for SO2 levels. For the two-pollutant model, NO2 and O3 were significant in combination with each of the other four pollutants on warm days. This study provides evidence that higher levels of ambient air pollutants increases the risk of hospital admissions for COPD in Taiwan.

Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long‐term trends

Exacerbations requiring hospital admission for chronic obstructive pulmonary disease (COPD) contribute to a decline in health status and are costly to the community. Long-term trends in admissions and associated outcomes are difficult to establish because of frequent readmissions, high case fatality and potential diagnostic transfer between COPD and asthma. The Western Australian Data Linkage System provides a unique opportunity to examine admissions for patients with COPD over the long term. Nineteen years of hospital morbidity data, based on International Classification of Diseases-9 criteria were extracted from the Western Australian Data Linkage System (1980-1998) and merged with mortality records to examine trends in hospital admissions for COPD. The rate of hospital admissions for COPD has declined overall and the rate of first presentation declined in men and remained constant in women. The risk of readmission increased throughout the period (P < 0.0001) and more than half of all admissions were followed by readmission within a year. Median survival following first admission was 6 years (men 5 years; women 8 years). Age, sex and International Classification of Diseases subcategory each showed an independent effect on the risk of mortality (P < 0.0001). The poorest survival was in patients subcategorized as emphysema. For patients with multiple admissions, the likelihood of cross-over between COPD and asthma was high and increased with the total number of admissions. The rate of admission for COPD has declined in Western Australia; however, the resource burden will continue to increase because of the ageing population. This has policy implications for the development of acute care treatment programmes for COPD.

Air Pollution and Hospital Admissions for Chronic Obstructive Pulmonary Disease in a Tropical City: Kaohsiung, Taiwan

This study was undertaken to determine whether there is an association between air pollutants levels and hospital admissions for chronic obstructive pulmonary disease (COPD) in Kaohsiung, Taiwan. Hospital admissions for COPD and ambient air pollution data for Kaohsiung were obtained for the period from 1996 to 2003. The odds ratio of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days (≥25°C) statistically significant positive associations were found in all pollutants except sulphur dioxide (SO2). On cool days (< 25°C), all pollutants were significantly associated with COPD admissions. For the two-pollutant models, CO and O3 were significant in combination with each of the other four pollutants on warm days. On cool days, NO2 remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient pollutants increase the risk of hospital admissions for COPD.

Mortality of Elderly Patients in Ontario after Hospital Admission for Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is associated with significant mortality. It is currently the fourth leading cause of death in Canada and the world. To describe the mortality of elderly patients in Ontario after hospital admission for COPD. A retrospective cohort study was conducted using the Discharge Abstract Database from the Canadian Institute for Health Information. Patients aged 65 years and older who were admitted to hospital between 2001 and 2004 with primary discharge diagnoses labelled with International Classification of Diseases, Ninth Revision codes 491, 492 and 496 were included in the study. Mortality rates were 8.81, 12.10, 14.53 and 27.72 per 100 COPD hospital admissions at 30, 60, 90 and 365 days after hospital discharge, respectively. Mortality also increased with age, and men had higher rates than women. No significant differences in mortality rates were found between different socioeconomic groups (P>0.05). Patients with shared care of a family physician or general practitioner and a specialist had significantly lower mortality rates than the overall rate (P<0.05), and their rates were approximately one-half the rate of patients with only one physician. Hospitalization with COPD is associated with significant mortality. Patients who were cared for by both a family physician or general practitioner and a specialist had significantly lower mortality rates than those cared for by only one physician, suggesting that continuous and coordinated care results in better survival.

How different measures of cold weather affect chronic obstructive pulmonary disease (COPD) hospital admissions in London

Many COPD sufferers find that their symptoms become worse during colder weather, which can lead to an exacerbation resulting in hospital admission. This study investigates different measures of cold, assessing which most strongly relate to COPD admissions and whether they can be used to forecast risk of exacerbation. COPD admissions (ICD10 J40–J44) for the five Strategic Health Authorities (SHAs) in London and corresponding meteorological data were extracted for October–March 1997–2003. Correlations and regressions were used to compare the effects on admissions of: daily mean, maximum and minimum temperature; significant drops in temperature; weekly average maximum temperature; “cumulative cold”, summing the number of degrees the daily maximum temperature was below a threshold across a week; different windchill indices. All measures of cold showed significant negative correlations with COPD admissions. Daily relationships were weaker than weekly ones (R = −0.19, p Cold measures explain sufficient variation in COPD hospital admissions to be used in a forecast model of risk of exacerbation. The Met Office uses such a model in a health forecasting and anticipatory care service in England.

The Effect of Fine Particulate Air Matter on Emergency Admissions For Copd and Pneumonia: a Multi-City Case-Crossover Analysis

P-078 Introduction: While many studies have examined the effects of air pollution on mortality, fewer studies have examined hospital admissions for pneumonia and COPD, and generally in smaller multi-city or single city studies. In addition, PM2.5 data has only recently been available. Method: We conducted a multi-city case-crossover study of the acute effect of PM2.5 on the increased risk of being admitted to the hospital among the elderly in thirty-nine US cities with 451,000 admissions for pneumonia and 234,000 admissions for chronic obstructive pulmonary disease (COPD). We examined the association between daily fine particulate air matter (PM2.5) and Medicare data (age ge 65) on hospital admissions from the emergency room with a primary diagnosis of COPD (ICD-9: 490–496, except 493) and pneumonia (ICD-9: 480–487), in those cities for the years 1999–2003. In the first stage of the analysis, we applied a case-crossover design in each city with referent exposure days chosen using the time-stratified approach, with control days matched on year, month, and temperature to control possible residual confounding by weather. In the second stage of the analysis we combined the city-specific estimates using a random effect approach. Results: For COPD we found the higher effect at lag 1 with an increase of 1.17% (95% CI: 0.3%, 2.0%) for a 10 μg/m3 increase in PM2.5. We found a 1.51% increase (95% CI: 0.5%, 2.6%) in risk of admissions for pneumonia and PM2.5 two days before. Matching on every third day yielded similar results. Discussion and Conclusion: We conclude that our analysis showed an increased risk of hospitalization for COPD and pneumonia associated with PM2.5 among the elderly. More studies are needed to understand the biological mechanism and to examine effect modification.

Sensitivity of the estimated air pollution–respiratory admissions relationship to statistical model choice

The objective of this study was to demonstrate the methodological shortcomings of currently available analytical methods for single-city time series data. We analyzed daily Chronic Obstructive Pulmonary Disease (COPD) and daily asthma hospital admissions in Melbourne, Australia from July 1989 to December 1992. Air pollution data comprised nitrogen dioxide, ozone and sulphur dioxide and air particles index consistent with particulates between 0.1 and 1 μm in aerodynamic diameter. Statistical analyses were performed using generalized linear models, generalized additive models, Poisson autoregressive models and transitional regression models. The estimated effect of nitrogen dioxide on COPD hospital admissions was similar across the different statistical models, RR = 1.06 (95% CI 1.01–1.11). Similarly the estimated effect of nitrogen dioxide on asthma hospital admissions was also consistent, RR = 1.05 (95% CI 1.01–1.09). However, the effects of ozone, air particles index and sulphur dioxide were highly sensitive to model specification for both COPD and asthma hospital admissions. In single-city studies of air pollution and respiratory disease, very different conclusions can be drawn from competing models. Furthermore, real time series data have greater complexity than any of the commonly-used existing models allow. Consequently, single-city studies should use several statistical models to demonstrate the stability of estimated effects.

β-Blocker Therapy in Veterans with Asthma or Chronic Obstructive Pulmonary Disease

To determine whether an association exists between health care resource use and beta-blocker therapy in patients with asthma or chronic obstructive pulmonary disease (COPD), and to determine whether any significant differences exist between type of beta-blocker agent administered and resource use. Retrospective cohort study. Three Veterans Administration (VA) databases with information from hospitals and clinics in Iowa and Nebraska. Patients. A total of 8390 veterans with a diagnosis of asthma or COPD receiving treatment with a beta-blocker or another cardiovascular agent. Clinic visits and hospital admissions for asthma or COPD that occurred in 2000-2001 were identified using electronic administrative data files. Analyses were adjusted for comorbidity and patient demographics. Mean patient age was 67 years, and 97% of the patients were men. In unadjusted analyses, patients taking beta-blockers had more hospital admissions, similar inpatient length of stay (LOS), and fewer outpatient clinic visits for asthma or COPD. In adjusted analyses, however, no difference was noted in the odds of hospital admission or in LOS, and patients had fewer clinic visits related to asthma or COPD. The hazard ratio for hospital admission for asthma or COPD during the observation year was similar for patients taking and not taking beta-blockers, and no difference was noted with selective versus nonselective beta-blockers. However, the hospital admission rate was lower with atenolol than metoprolol. Patients taking beta-blockers did not have more hospital admissions or clinic visits for their asthma or COPD than patients not taking these agents. When clinically indicated, beta-blockers-especially atenolol-should be considered for patients with asthma or COPD.

Chronic obstructive pulmonary disease and asthma in the ICU

Chronic obstructive pulmonary disease (COPD) and asthma are both common respiratory problems that can present acutely with severe respiratory failure. Both are characterized by the presence of air flow limitation, which is variable in asthma and usually fixed in COPD. Chronic respiratory failure usually develops in COPD once FEV1 falls to less than 30% of predicted. Patients are often hospitalized during exacerbations, when further carbon dioxide retention and respiratory acidosis occur. The use of controlled oxygen therapy remains important and, in a significant number of patients, acidosis is reduced when this is initiated. Regular bronchodilators, steroids and suitable antibiotics are standard therapy for exacerbations. In patients with a significant respiratory acidosis (pH less than 7.35), non-invasive ventilation (NIV) has been shown to improve hospital survival in several randomized controlled trials. If NIV is unsuccessful, intubation should be considered. This decision can be difficult and should be discussed with the patient, family and senior team members. Mortality following hospital admission for COPD is about 11% and 2-year survival is about 50%. Following intubation, 1-year survival is less than 50%. Most patients with acute severe asthma respond rapidly to a combination of oxygen therapy, nebulized bronchodilators, steroids, ipratropium bromide and intravenous magnesium sulphate. A small number of asthmatic patients fail to respond to medical therapy and need intubation and ventilation. Hypotension following intubation is common and responds to volume replacement and controlled hypoventilation. Oxygenation is usually straightforward. Low tidal volumes and the use of prolonged expiratory times should be used to limit gas trapping. This often produces moderate hypercapnia, which is well tolerated. Outcome from acute severe asthma is good, with less than 0.1% mortality. However, in intubated patients, mortality rises to over 8%.