Primary Diagnosis Of Chronic Obstructive Pulmonary Disease Research Articles

The impact of comorbid psychiatric disorders on chronic obstructive pulmonary disease (COPD) hospitalizations: a nationwide retrospective study.

To characterize the register of a secondary diagnosis of mental illnesses in all chronic obstructive pulmonary disease (COPD) hospitalizations registered in Portugal from 2008 to 2015 and explore their impact on hospitalization outcomes. A retrospective observational study was conducted. Hospitalizations of patients with at least 40 years old, discharged between 2008 and 2015 with a primary diagnosis of COPD (ICD-9-CM codes 491.x, 492.x and 496) were retrieved from a national administrative database. Comorbid psychiatric diagnoses were identified and defined by the HCUP Clinical Classification Software (CCS) category codes 650-670 (excluding 662). Length of hospital stay (LoS), admission type, in-hospital mortality, and estimated hospital charges were analyzed according to psychiatric diagnostic categories using sex and age-adjusted models. Of 66,661 COPD hospitalizations, 25,869 (38.8%) were episodes with a registered psychiatric comorbidity. These were more likely to correspond to younger inpatients (OR = 2.16, 95%CI 2.09-2.23; p < 0.001), to stay longer at the hospital (aOR = 1.08, 95%CI 1.05-1.12; p < 0.001), to incur in higher estimated hospital charges (aOR = 1.37, 95%CI 1.33-1.42; p < 0.001) and to be urgently admitted (aOR = 1.33, 95%CI 1.23-1.44; p < 0.001). After adjustment for age, in-hospital mortality was lower for episodes with psychiatric diagnoses (aOR = 0.90; 95%CI 0.84-0.96; p < 0.001), except for organic and neurodegenerative diseases category and developmental disorders, intellectual disabilities and disorders usually diagnosed in infancy, childhood, or adolescence category. These findings corroborate the additional burden placed by psychiatric disorders on COPD hospitalizations, highlighting the importance of individualizing care to address these comorbidities and minimize their impact on treatment outcomes.

Secular trend and risk factors of 30-day COPD-related readmission in Beijing, China

Readmission due to chronic obstructive pulmonary disease (COPD) exacerbation contributes significantly to disease burden. Trend in readmission rate among COPD patients in China is not well characterized. We described the secular trend and identify risk factors of COPD-related 30-day readmission in Beijing during 2012–2017. In this retrospective cohort study, we used data from a citywide hospital discharge database in Beijing. We included patients ≥ 40 years with a primary diagnosis of COPD from 2012 to 2017. A total of 131 591 index admissions were identified. COPD-related 30-day readmission was defined as the initial admission with a primary diagnosis of COPD that occurs within 30 days from the discharge date of an index admission. Overall and annual 30-day readmission rates were calculated in the total population and subgroups defined by patient characteristics. We used multivariable logistic models to investigate risk factors for readmission and in-hospital mortality within 30 days. The overall 30-day COPD-related readmission rate was 15.8% (n = 20 808). The readmission rate increased from 11.5% in 2012 to 17.2% in 2017, with a multivariable-adjusted OR (95% CI) for annual change to be 1.08 (1.06–1.09) (P trend < 0.001). The upward trend in readmission rate levelled off at about 17% since 2014. The readmission rate of men was higher and increased faster than women. Comorbid osteoporosis, coronary heart disease, congestive heart failure, and cancer were associated with an increased risk of 30-day COPD-related readmission. The 30-day COPD-related readmission rate in Beijing showed an overall increasing trend from 2012 to 2017. Future efforts should be made to further improve care quality and reduce early readmissions of COPD patients.

0584 Impact of Obstructive Sleep Apnea on Chronic obstructive pulmonary disease Hospitalizations

Abstract Introduction Obstructive sleep apnea (OSA) is a sleep disorder that has been linked to increase the risk for hypertension, ischemic heart failure, arrhythmia and heart failure. There are multiple similarities between OSA and Chronic Obstructive Pulmonary Disease (COPD); both are associated with hypoxia and hypercapnia, with different mechanisms of hypoxia; in COPD its chronic and slow progression, whereas it is suddenly intermittent hypoxia in OSA. Intermittent hypoxia was hypothesized to enhance the protective effect on subsequent hypoxia resulting in cardioprotective effect [1]. There is little data on rates of in-hospital mortality on patients with OSA and COPD using a nationwide study. In this study, we aim to analyze the impact on mortality and length of hospital stay of obstructive sleep apnea in patients with COPD. Methods Adults with principal diagnosis of COPD were selected from the 2019 US National Inpatient Sample, using ICD 10 code primary diagnosis on discharge. We queried the 2019 National Inpatient Sample for OSA, and other secondary diagnoses (hyperlipidemia, hypertension, heart failure, smoking, CKD, electrolytes disturbances). Confounders were adjusted for using multivariable linear regression analysis for other secondary diagnoses. Results In a total of 520,624 adult hospitalizations with COPD primary diagnosis on discharge were included from the 2019 national inpatient sample. 73,705 patients had concomitant secondary diagnosis with OSA. On weighted analysis, hospitalizations with primary diagnosis of COPD and secondary diagnosis of OSA had lower in-hospital mortality rates compared to hospitalizations with COPD alone (0.6% vs 1.08%, p= 0.000), .COPD hospitalizations with OSA had statistically significant lower odds for mortality compared to COPD patients without OSA (adjusted OR 0.73, 95% CI 0.57-0.93; p= 0.009).However, COPD hospitalizations with OSA showed increased in the mean length of stay by 0.21 days (95% CI 0.12-0.30, p=0.000) compared to patients without OSA. Conclusion Our analysis showed better mortality outcomes for COPD patients with OSA , supporting the protective effect hypothesis of intermittent hypoxia. COPD patients with concomitant secondary OSA diagnosis have increased in-hospital length of stay. Support (If Any) 1- Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74:1124–1136

Continuity of Care Assessment Within a Vertically Integrated Care Management Organization Before and After COPD-Related Exacerbations.

BackgroundThere is currently little research describing patient experience and continuity of care immediately prior, during, and following an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This analysis examined clinical characteristics, chronic obstructive pulmonary disease (COPD)‑related medication patterns and outpatient visits before and after an AECOPD.MethodsThis retrospective analysis used electronic health records, medical claims, and pharmacy dispensing data for patients within the Kaiser Permanente Northwest Health System. Patients with ≥1 AECOPD between January 1, 2015 and December 31, 2017 were identified. The most recent AECOPD was considered the index date. An AECOPD was defined as an inpatient hospitalization with a primary diagnosis of COPD, or respiratory failure with a secondary diagnosis of COPD, or an outpatient visit with a primary diagnosis of COPD and dispensing of respiratory-related antibiotics and/or oral corticosteroids ±5 days of the visit. Eligible patients were: ≥40 years old; ≥2 encounters within 12 months of each other or ≥1 hospitalization with primary or secondary COPD diagnosis, chronic bronchitis, or emphysema prior to index; and continuously enrolled ±90 days relative to index. COPD-related inhaled maintenance medication, rescue inhalers, oral corticosteroid use, and ambulatory visits were assessed 90-days pre- and post-index.ResultsThere were 2829 patients included (mean [standard deviation] age: 69.0 [10.5] years) who had an AECOPD (7% severe; 93% moderate). The percentage of patients on inhaled maintenance therapy increased from 60.6% pre-AECOPD to 68.8% post-AECOPD and increased from 60.0% to 87.4% among patients who experienced a severe AECOPD. COPD-related ambulatory visits increased more than four-fold for primary care and more than doubled for pulmonologist visits in the post-AECOPD period.ConclusionThe low proportion of patients observed with changes to controller and rescue medication (particularly following a moderate AECOPD), yet higher utilization of COPD-related ambulatory visits before and after an AECOPD suggests that there is opportunity to improve pharmacotherapy management.

COPD AND PSYCHIATRIC ILLNESSES: A STUDY OF EPEDMIOLOGY AND EFFECTS ON MORTALITY

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that involves persistent respiratory symptoms and airflow limitation. Several studies have shown increased prevalence of psychiatric illness (PI) in patients with COPD; however, prevalence rates vary widely. Hypoxemia in COPD has been associated with increased risk of cognitive and neuropsychiatric impairment while depression was associated with lower treatment adherence in patients with COPD. Despite these associations, studies investigating the effects of PI on COPD mortality and readmission remain inconclusive. This study aims to describe the prevalence of PI in COPD and evaluate the effect of PI on in-hospital mortality and 30-day readmissions using large United States population-based dataset. METHODS: Data were abstracted from the 2010 to 2018 Nationwide Readmissions Database (NRD). Hospitalizations with a primary diagnosis of COPD were identified using Diagnosis Related Groups 190 to 192 and/or All Patients Refined-Diagnosis Related Groups 140; International Classification of Diseases-9/10-Clinical Modification codes were used to identify secondary PI diagnoses of major depression, bipolar disorder, post-traumatic stress disorder, anxiety disorder, somatoform disorder, sleep-related disorders, eating disorders, and/or alcohol use disorder. Multivariable logistic regression models were estimated to evaluate the effect of PI on mortality and 30-day readmissions. All analyses accounted for the NRD sampling design. RESULTS: A total of 6,452,636 hospitalizations with COPD occurred between 2010 and 2018. Of these, 2,160,417 (34%) carried at least one PI diagnosis. The most prevalent PI was anxiety disorder (58%) followed by sleep-related disorders (26%), and major depression (20%); Concomitant PI was more prevalent in hospitalizations in which patients were younger, female, nicotine users, and obese (P-value <0.001).Hospitalizations with concomitant PI had higher adjusted mortality rate [adjusted odds ratio (aOR): 1.07; 95% confidence interval (CI): 1.04-1.10, P-value <0.001], as well as higher 30-day readmission rates [aOR: 1.21, 95% CI: 1.20-1.22, P-value <0.001]. CONCLUSIONS: This study demonstrates that in the United States from 2010 to 2018, approximately one-third of COPD hospitalizations have a concomitant PI that is associated with higher mortality and 30-day readmission rates. CLINICAL IMPLICATIONS: COPD patients with PI should be recognized as a vulnerable population at increased risk for in-hospital mortality and 30-day readmission. Further studies are needed to develop tools and measures that help identify and screen this group of patients. DISCLOSURES: No relevant relationships by Yaman Alali, source=Web Response No relevant relationships by Abedel Rahman Anani, source=Web Response No relevant relationships by Adam Highley, source=Web Response No relevant relationships by Ian Jackson, source=Web Response No relevant relationships by Austin Loranger, source=Web Response No relevant relationships by Ryan Walters, source=Web Response

A Case series on Asthma-COPD overlap (ACO) is independent from other chronic obstructive diseases (COPD and Asthma)

As we know that, Asthma and chronic obstructive pulmonary diseases are well characterized diseases, they can co-exist as asthma-COPD overlap (ACO). The co-existence of asthma-chronic obstructive pulmonary disease overlap (ACO) in chronic obstructive pulmonary disease (COPD) patients is often unrecognized. In patients with a primary diagnosis of COPD or Asthma, the identification of ACO has got implication for better prognosis and treatment. Such patients experience frequent exacerbations, poor quality of life, rapid decline in lung function and high mortality than COPD or Asthma alone. Inhalational steroids provide significant alleviation of symptoms in such patients and some studies suggest that the most severe patients may respond to biological agents indicated for severe asthma. Patients who have asthma with a COPD component tend to present with severe hypoxia because of Irreversible/fixed airway obstruction and impairment of the alveolar diffusion capacity by emphysematous changes. In contrast, patients with COPD who have an asthma component not only have exertional dyspnoea but also develop paroxysmal wheezing or dyspnoea at night or in the early morning. The criteria to diagnose asthma-COPD overlap (ACO) include positive bronchodilator response, sputum eosinophilia or previous diagnosis of asthma, high IgE and/or history of atopy. There is scarcity of literature available in country like India. We highlight the importance of identification of Asthma COPD overlap as different phenotype from COPD or asthma alone as it is challenging to diagnose ACO in India. We report 3 cases having both the features of asthma and COPD, later diagnosed with Asthma-COPD overlap.

Update on Asthma-COPD Overlap (ACO): A Narrative Review.

Although chronic obstructive pulmonary disease (COPD) and asthma are well-characterized diseases, they can coexist in a given patient. The term asthma–COPD overlap (ACO) was introduced to describe patients that have clinical features of both diseases and may represent around 25% of COPD patients and around 20% of asthma patients. Despite the increasing interest in ACO, there are still substantial controversies regarding its definition and its position within clinical guidelines for patients with obstructive lung disease. In general, most definitions indicate that ACO patients must present with non-reversible airflow limitation, significant exposure to smoking or other noxious particles or gases, together with features of asthma. In patients with a primary diagnosis of COPD, the identification of ACO has therapeutic implication because the asthmatic component should be treated with inhaled corticosteroids and some studies suggest that the most severe patients may respond to biological agents indicated for severe asthma. This manuscript aims to summarize the current state-of-the-art of ACO. The definitions, prevalence, and clinical manifestations will be reviewed and some innovative aspects, such as genetics, epigenetics, and biomarkers will be addressed. Lastly, the management and prognosis will be outlined as well as the position of ACO in the COPD and asthma guidelines.

CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD

SESSION TITLE: Abstracts - Monday Award Semifinalists SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Chronic obstructive pulmonary disease (COPD) is a common indication for lung transplantation. Long term survival remains poor following either single or double lung transplantation, and the causes of mortality post transplantation remain unknown. We hypothesized that there would be differences in survival between single and double lung transplantation in COPD. As the residual lung may contribute to outcomes, we also hypothesized that the causes for mortality would be different in single lung transplantation compared with double lung transplantation. METHODS: We analyzed subjects listed in the United Network for Organ Sharing (UNOS) database with primary diagnosis of COPD who received lung transplants after implementation of the Lung Allocation Score (LAS). We excluded subjects who were listed for lung retransplantation or for multiple organ transplant or who were lost to follow-up. Major categories of cause-specific mortality included respiratory, cardiovascular, malignant, non-pulmonary infection, and miscellaneous. Cox proportional hazards analyses were performed to compare all-cause mortality in single vs double lung transplant recipients adjusting for age at transplant, ethnicity, pre-transplant FEV1, pre-transplant 6 minute walk distance, pre-transplant Karnofsky score, and pre-transplant BMI. Similar analyses were performed for cause-specific mortality. RESULTS: We included 4,882 lung transplant recipients; 36.9% were single lung recipients. Mean age was 60.9 years (SD 6.1), 51.7% were male, and 90.6% were white. The median duration of follow-up was 3.0 years (IQR 1.0–5.8). Compared with single lung transplant, receipt of double lung transplant was associated with improved survival (HR 0.81, 95% CI 0.74-0.89;p CONCLUSIONS: Analysis of the UNOS database since implementation of the LAS indicates that likely drivers of mortality differences in single vs. double lung transplant recipients are higher rates of death from respiratory causes and cancer in single lung transplant patients. CLINICAL IMPLICATIONS: Identifying causes of mortality post single and double lung transplant for COPD will enable targeted interventions for these individuals DISCLOSURES: Consultant relationship with NIH Please note: $1001 - $5000 Added 03/15/2019 by Surya Bhatt, source=Web Response, value=Consulting fee Removed 03/15/2019 by Surya Bhatt, source=Web Response PI relationship with NIH Please note: >$100000 Added 03/15/2019 by Surya Bhatt, source=Web Response, value=Grant/Research Consultant relationship with Sunovion Please note: $1001 - $5000 Added 03/15/2019 by Surya Bhatt, source=Web Response, value=Consulting fee No relevant relationships by Rachel Naramore, source=Web Response No relevant relationships by Keith Wille, source=Web Response

Low cost device for early diagnosis of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterised by increasing breathlessness. In the early stages of the disease, the symptoms are unnoticed. The symptoms are seen in the more developed stages of the disease. Hence it is important for us to develop an easy to use device for diagnosis. The proposed device solves the purpose of primary diagnosis of COPD, which enables the patient to do a self-test of his lungs capacity. The sensor system of the device includes a rotary sensor which enables the patient to have precise and accurate information every time. The device has a modern and interactive application which gives the patient access to a detailed report on his lungs condition. The application also features exercise mode in which the patient can do simple breathing exercises to prevent and treat chronic obstructive pulmonary disease in the early stage. The device has been tested with 87% accuracy.

Three-Year Hospitalization and Mortality in Elderly Smokers with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure

Background: In elderly smokers, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) usually present with dyspnoea. COPD and CHF are associated ­almost invariably with concomitant chronic diseases, which contribute to severity and prognosis. Objectives: We investigated similarities and differences in the clinical presentation, concomitant chronic diseases and risk factors for ­mortality and hospitalization at 3-year follow-up in elderly smokers/ex-smokers with a primary diagnosis of COPD or CHF recruited and followed in specialized centers. Methods: We examined 144 patients with COPD and 96 with CHF, ≥65 years, ≥20 pack/years, and measured COPD Assessment Test (CAT) score, modified Medical Research Council, NYHA, and Charlson Index, routine blood test, estimated glomerular filtration rate, HRCT scan, 6-min walk test. In addition, in each patient we actively searched for CHF, COPD, peripheral vascular disease, and metabolic syndrome. Results: COPD and CHF patients had mild to moderate disease, but the majority was symptomatic. Comorbidities were highly prevalent and often unrecognized in both groups. COPD and CHF patients had a similar risk of hospitalization and death at 3 years. Lower glomerular filtration rate, shorter 6MWT, and ascending aorta calcification score ≥2 were independent predictors of mortality in COPD, whereas previous 12 months hospitalizations, renal disease, and heart diameter were in CHF patients. Lower glomerular filtration rate value, higher CAT score, and lower FEV₁/FVC ratio were associated with hospitalization in COPD, while age, lower FEV₁% predicted, and peripheral vascular disease were in CHF. Conclusions: There are relevant similarities and differences between patients with COPD and CHF even when admitted to specialized outpatient centers, suggesting that these patients should be manage in multidisciplinary units.

Relationship of Blood Eosinophil Count to Exacerbations in Chronic Obstructive Pulmonary Disease

Eosinophilic airway inflammation characterizes a chronic obstructive pulmonary disease (COPD) phenotype that requires more study. To investigate the relationship of blood eosinophil count to exacerbations in COPD. Using administrative pharmacy and health care utilization data from 2009 to 2012, we retrospectively identified patients 40 years or older with a COPD diagnosis, postbronchodilator FEV1/forced vital capacity ratio of less than 0.7, and a blood eosinophil count (N= 7,245). COPD exacerbations were defined as hospitalizations or emergency department visits with a primary diagnosis of COPD, or outpatient visits with systemic corticosteroid dispensing within ±14 days associated with an encounter code consistent with a COPD exacerbation. The relationship between the index blood eosinophil count and the rate of COPD exacerbations in the follow-up year was determined by multivariable analyses. Patients with COPD were predominantly male (57.1%), white (71.8%), often current or past smokers (75.4%), and had frequent comorbidities; 19.0% had eosinophil counts of greater than or equal to 300 cells/mm3, 76.1% were classified as moderate to very severe by lung function, and the COPD exacerbation rate was 0.38 per year (95% CI, 0.37-0.40). After adjustment for potential confounders, COPD exacerbations during 1-year follow-up were significantly greater for patients with blood eosinophil counts of greater than or equal to 300 cells/mm3 (rate ratio [RR], 1.25; 95% CI, 1.10-1.43), greater than or equal to 400 cells/mm3 (RR, 1.48; 95% CI, 1.26-1.75), and greater than or equal to 500 cells/mm3 (RR, 1.76; 95% CI, 1.45-2.14), respectively, compared with patients with eosinophils lower than the cutoffs. In this study, high blood eosinophil counts were an independent risk factor for future exacerbations in patients with COPD, a phenotype that might benefit from therapy directed at eosinophilic-driven disease and inflammation.

Effects of pulmonary rehabilitation on exercise capacity and disease impact in patients with chronic obstructive pulmonary disease and obesity

ObjectivesTo explore the influence of obesity on outcomes of exercise capacity and disease impact in patients with chronic obstructive pulmonary disease (COPD) in response to pulmonary rehabilitation (PR) and to compare outcomes to those of normal weight and overweight counterparts. DesignSecondary data analysis of clinical database. SettingSt. James’s Hospital, Dublin, Ireland. Participants155 participants with a primary diagnosis of COPD who completed a PR programme between 2012 and 2014. Main Outcome MeasuresExercise capacity evaluated using the Six Minute Walk Test (6MWT) and the COPD Assessment Test (CAT) evaluated disease impact. ResultsWalking distance in the 6MWT improved significantly [mean difference of 55m (95% CI: 42 to 68; p<0.001)] and similarly [F(2, 92)=1.434, p=0.24] across all BMI categories, although the level of improvement reached clinical significance in the normal/underweight and overweight categories only. Disease impact on the CAT score improved across all body mass index (BMI) classifications by 2.3 points (95% CI: 0.9 to 3.6; p<0.050) which reached clinical significance and did not vary across BMI categories [F(2, 80)=0.534, p=0.58]. ConclusionExercise capacity and self-report disease impact of individuals with COPD improved similarly in response to PR irrespective of BMI.

Association Between Statin Medications and COPD-Specific Outcomes: A Real-World Observational Study.

BackgroundDisease-modifying drugs are not yet available for the management of chronic obstructive pulmonary disease (COPD). HMG-CoA reductase inhibitors (statins) have anti-inflammatory properties and are therefore being considered for use in the management of COPD.ObjectiveOur objective was to examine the association between statin use and COPD-specific outcomes in a real-world setting.MethodsThis was a retrospective longitudinal dynamic cohort study that used Medicaid claims data from multiple years (2005–2008) to identify patients with newly diagnosed COPD. Statin therapy was determined from the prescription drug file using National Drug Codes (NDCs). COPD-specific outcomes such as hospitalizations and emergency room and outpatient visits were identified based on a primary diagnosis of COPD. Multivariable logistic regressions with inverse probability treatment weights (IPTWs) were used to examine the relationship between statin therapy and COPD-specific outcomes.ResultsThe study included 19,060 Medicaid beneficiaries with newly diagnosed COPD, 30.3% of whom received statins during the baseline period. Adults who received statins had significantly lower rates of COPD-specific hospitalizations (4.7 vs. 5.2%; p < 0.05), emergency room visits (13.4 vs. 15.4%; p < 0.001), and outpatient visits (41.4 vs. 44.7%; p < 0.001) than those who did not receive statin therapy. Even after adjusting for observed selection bias with IPTWs, adults receiving statins were less likely to have COPD-specific hospitalizations [adjusted odds ratio (AOR) 0.76; 95% confidence interval (CI) 0.66–0.87], emergency room visits (AOR 0.81; 95% CI 0.75–0.89), and outpatient visits (AOR 0.86; 95% CI 0.80–0.91) than those not receiving statins.ConclusionsFindings from this study suggest statins have beneficial effects in patients with newly diagnosed COPD and warrant further clinical trial investigation.

Chronic obstructive pulmonary disease and anxiety disorders: a nationwide population-based study in Taiwan.

Few studies have investigated the relationship between chronic obstructive pulmonary disease (COPD) and anxiety disorder outcomes. We sought to investigate the association in a large national sample. Cases were identified from Taiwan's National Health Insurance Research Database who were aged 15 years and above, with a new primary diagnosis of COPD (International Classification of Diseases, Ninth Revision codes: 491, 492, 494 and 496) between 2000 and 2007. The 29,951 cases identified were compared to 29,951 controls matched on sex, age, urban/rural residence and socioeconomic status based on insurance premium. Both groups were followed until the end of 2008 for instances of anxiety disorders. Competing risk-adjusted Cox regression analyses were applied, adjusting for matching variables, Charlson comorbidity index, hospital admission days and daily dose of prednisone. Of the 59,902 subjects, 3951 were found to have anxiety disorders during a mean (SD) follow-up period of 5.5 (2.5) years. COPD, female, urban residence, lower dose of prednisone use, depressive disorders and higher outpatient visits were independent predictors of incident anxiety disorder. COPD was associated with increased risk of an anxiety disorder diagnosis, independent of a number of potential confounding factors.

Risk of bipolar disorder in patients with COPD: a population-based cohort study.

Few studies have investigated the relationship between chronic obstructive pulmonary disease (COPD) and bipolar outcomes in the world. We sought to investigate the association between COPD and risk of bipolar disorder in a large national sample. The insured aged 15years or more with a new primary diagnosis of COPD (ICD-9: 491, 492, 494 and 496) between 2000 and 2007 were identified from Taiwan's National Health Insurance Research Database. We included individuals with an inpatient diagnosis of COPD and/or at least 1year of two diagnoses of COPD in outpatient services. These 35,558 cases were compared to 35,558 sex-, age-, residence- and insurance premium-matched controls. We followed both groups until the end of 2008 for incidence of bipolar disorder, defined as ICD-9 codes 296.0-296.16, 296.4-296.81 and 296.89. Competing risk-adjusted Cox regression analyses were applied with adjusting for sex, age, residence, insurance premium, prednisone use, Charlson comorbidity index, diabetes, hypertension, hyperlipidemia, cardiovascular diseases, hospital admission days, outpatients' visits and mortality. Of the total 71,116 subjects, 202 were newly diagnosed with bipolar disorder during the study period. The mean follow-up time was 6.0(SD=2.2)years. COPD, younger age, lower economic status, lower dose of prednisone use, higher hospital admission days and higher outpatient visits were independent predictors of bipolar disorder. COPD was associated with increased risk of bipolar disorder independent of a number of potential confounding factors in this study.

Increased expression of A Proliferation-Inducing Ligand (APRIL) in lung leukocytes and alveolar epithelial cells in COPD patients with non small cell lung cancer: a possible link between COPD and lung cancer?

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by an excessive activation of the adaptive immune system and, in particular, uncontrolled expansion of the B-cell pool. One of the key promoters of B cell expansion is A PRoliferation-Inducing Ligand (APRIL). APRIL has been strongly linked to non small cell lung cancer (NSCLC) onset and progression previously. However, little is known about the expression of APRIL in the lungs of COPD patients.&#x0D; Methods: Using immuno-fluorescence staining, the expression of APRIL was assessed in sections of lungs from 4 subjects with primary diagnosis of COPD (FEV1 33 ± 20 % predicted), 4 subjects with primary diagnosis of NSCLC, 4 subjects diagnosed with both COPD and NSCLC, smokers without COPD or NSCLC and 3 healthy never-smokers. The percentage of B cells, alveolar macrophages (AMs) and polymorphonuclear neutrophils (PMNs) in the lung and alveolar epithelial cells (AECs) that stained positively for APRIL was quantified using epi-fluorescence microscopy and image analysis software.&#x0D; Results: The percentage of APRIL-expressing B cells, AMs, PMNs and alveolar epithelial cells (AECs) was higher in patients having both COPD and NSCLC than in patients with either COPD or NSCLC alone, SC or NSC (p &lt; 0.03 for all comparisons). The percentage of APRIL-expressing AMs and AECs (but not in B cells) was higher in patients with NSCLC alone than in patients with COPD alone. The percentage of APRIL-expressing AECs (but not B cells or AMs) was higher in COPD patients than in SC and NSC (p &lt; 0.05 for all comparisons). The percentage of APRIL-expressing B cells, AMs and AECs cells was similar in NSC and SC.&#x0D; Conclusion: The percentage of APRIL-expressing B cells, AMs and AECs is higher in the lungs of patients with both COPD and NSCLC than in patients with COPD or NSCLC alone or control subjects. These findings suggest that APRIL may contribute to the pathogenesis of both COPD and NSCLC, and possibly to the development of NSCLC in patients with established COPD.

Increased expression of A Proliferation-inducing Ligand (APRIL) in lung leukocytes and alveolar epithelial cells in COPD patients with non small cell lung cancer: a possible link between COPD and lung cancer?

BackgroundChronic Obstructive Pulmonary Disease (COPD) is characterized by an excessive activation of the adaptive immune system and, in particular, uncontrolled expansion of the B-cell pool. One of the key promoters of B cell expansion is A PRoliferation-Inducing Ligand (APRIL). APRIL has been strongly linked to non small cell lung cancer (NSCLC) onset and progression previously. However, little is known about the expression of APRIL in the lungs of COPD patients.MethodsUsing immuno-fluorescence staining, the expression of APRIL was assessed in sections of lungs from 4 subjects with primary diagnosis of COPD (FEV1 33 ± 20 % predicted), 4 subjects with primary diagnosis of NSCLC, 4 subjects diagnosed with both COPD and NSCLC, smokers without COPD or NSCLC and 3 healthy never-smokers. The percentage of B cells, alveolar macrophages (AMs) and polymorphonuclear neutrophils (PMNs) in the lung and alveolar epithelial cells (AECs) that stained positively for APRIL was quantified using epi-fluorescence microscopy and image analysis software.ResultsThe percentage of APRIL-expressing B cells, AMs, PMNs and alveolar epithelial cells (AECs) was higher in patients having both COPD and NSCLC than in patients with either COPD or NSCLC alone, SC or NSC (p < 0.03 for all comparisons). The percentage of APRIL-expressing AMs and AECs (but not in B cells) was higher in patients with NSCLC alone than in patients with COPD alone. The percentage of APRIL-expressing AECs (but not B cells or AMs) was higher in COPD patients than in SC and NSC (p < 0.05 for all comparisons). The percentage of APRIL-expressing B cells, AMs and AECs cells was similar in NSC and SC.ConclusionThe percentage of APRIL-expressing B cells, AMs and AECs is higher in the lungs of patients with both COPD and NSCLC than in patients with COPD or NSCLC alone or control subjects. These findings suggest that APRIL may contribute to the pathogenesis of both COPD and NSCLC, and possibly to the development of NSCLC in patients with established COPD.

Respiratory disease in the Asia-Pacific region: Cough as a key symptom.

Respiratory diseases represent a significant impact on health care. A cross-sectional, multicountry (India, Korea, Malaysia, Singapore, Taiwan, and Thailand) observational study was conducted to investigate the proportion of adult patients who received care for a primary diagnosis of asthma, allergic rhinitis (AR), chronic obstructive pulmonary disease (COPD), or rhinosinusitis. To determine the proportion of patients who received care for asthma, AR, COPD, and rhinosinusitis, and the frequency and main symptoms reported. Patients ages ≥18 years, who presented to a physician with symptoms that met the diagnostic criteria for a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Patients and physicians completed a survey that contained questions related to demographics and respiratory symptoms. A total of 13,902 patients with a respiratory disorder were screened, of whom 7030 were eligible and 5250 enrolled. The highest percentage of patients who received care had a primary diagnosis of AR (14.0% [95% confidence interval {CI}, 13.4-14.6%]), followed by asthma (13.5% [95% CI, 12.9-14.1%]), rhinosinusitis (5.4% [95% CI, 4.6-5.3%]), and COPD (4.9% [95% CI, 5.0-5.7%]). Patients with a primary diagnosis of COPD (73%), followed by asthma (61%), rhinosinusitis (59%), and AR (47%) most frequently reported cough as a symptom. Cough was the main reason for seeking medical care among patients with a primary diagnosis of COPD (43%), asthma (33%), rhinosinusitis (13%), and AR (11%). Asthma, AR, COPD, and rhinosinusitis represent a significant proportion of respiratory disorders in patients who presented to health care professionals in the Asia-Pacific region, many with concomitant disease. Cough was a prominent symptom and the major reason for patients with respiratory diseases to seek medical care.

Factors associated with inpatient readmission among managed care enrollees with COPD

Objective. To assess factors associated with inpatient readmission among a US managed care population with chronic obstructive pulmonary disease (COPD). Background. COPD is often accompanied by intermittent acute exacerbations, which may result in hospitalizations. These exacerbations are often associated with an increased frequency of subsequent exacerbations, which may lead to inpatient readmissions. Methods. We assessed US managed care claims data for enrollees ≥ 40 years old with an inpatient admission with a primary diagnosis of COPD (ICD-9-CM codes 491.xx, 492.xx or 496.xx) between 1 January 2010 and 31 December 2013 (discharge date of first observed inpatient admission defined the “index date”). Patients were required to be continuously enrolled for ≥ 12 months before the index date. Two non-mutually exclusive cohorts were analyzed: (1) patients with ≥ 30 days of post-index date continuous enrollment (to evaluate 30-day readmission) and (2) patients with ≥ 90 days of post-index date continuous enrollment (to evaluate 90-day readmission). Logistic regression evaluated the association between patient characteristics and risk of 30- and 90-day COPD-related and all-cause readmission. Results. After applying selection criteria, 140,981 patients had ≥ 30 days of enrollment post-index date, and 123,545 patients had ≥ 90 days of enrollment post-index date. Within 30 days, nearly 20% of patients had an all-cause readmission and 7% had a COPD-related readmission. Within 90 days, 28% had an all-cause readmission and 12% had a COPD-related readmission. Logistic regression indicated that longer length of stay, older age, greater comorbidity burden, specific comorbidities and COPD complexity were associated with significantly greater odds of COPD-related 30- and 90-day readmission. Results for all-cause readmission were generally similar. Conclusions. Many of the factors associated with inpatient readmission documented here can be ascertained at discharge and may be used to inform discharge plans, with the end goal of improving patient outcomes, including reducing the risk of readmission.

Chronic obstructive pulmonary disease predicts chronic rhinosinusitis without nasal polyps: A population-based study.

Few studies have investigated the relationship between chronic obstructive pulmonary disease (COPD) and chronic rhinosinusitis without nasal polyps (CRSsNP) outcomes. The aim of this study was to investigate the association between COPD and the risk of CRSsNP in a large national sample. Patients 15 years or older with a new primary diagnosis of COPD (International Classification of Diseases, Ninth edition [ICD-9], 491, 492, 494, and 496) between 2000 and 2007 were identified from the National Health Insurance Research Database of Taiwan. The patients were compared with sex-, age-, residence-, and insurance premium-matched controls, and both groups were followed up until the end of 2008 for instances of CRSsNP, defined as ICD-9 codes CRS (473, 473.0, 473.1, 473.2, 473.3, 473.8, and 473.9), excluding NP (471, 471.0, 471.1, 471.8, and 471.9). Competing risk-adjusted Cox regression analyses were applied after adjusting for sex, age, residence, insurance premium, steroid use (topical or systemic), hyperlipidemia, diabetes, hypertension, coronary artery disease, hospital admission days, and mortality. We included 34,029 cases and 34,029 matched controls in this study. Among the 68,058 subjects, 569 developed CRSsNP during a mean (standard deviation [SD]) follow-up period of 5.0 years (SD 2.2 years). COPD was an independent predictor of CRSsNP in the fully adjusted model (hazard ratio = 3.24; 95% CI = 2.65-3.96; p < 0.01). COPD was associated with an increased risk of CRSsNP in this study population, independent of a number of potential confounding factors.