Primary Diagnosis Of COPD Research Articles

Exacerbation History and Risk of Myocardial Infarction and Pulmonary Embolism in COPD

Acute exacerbations of COPD (AECOPDs) are increasingly recognized as episodes of heightened risk of cardiovascular events. It is not known whether exacerbation history is differentially associated with future myocardial infarction (MI) or pulmonary embolism (PE). Is the number and severity of AECOPDs associated with increased risk of MI or PE in a real-life cohort of patients with COPD? We identified a cohort of 66,422 patients (≥ 30 years of age) with a primary diagnosis of COPD in the Swedish National Airway Register from January 2014 to June 2022, with complete data on lung function. Patients were classified by moderate (prescription of oral corticosteroids) and severe (hospitalization) exacerbations the year before index date and were followed until December 2022 for hospitalization or death from MI or PE, corresponding to > 265,000 patient-years, with a maximum follow-up time of 9 years. Competing risk regression, according to the Fine-Gray model, was used to calculate subdistribution hazard ratios with 95%CIs. Compared with no AECOPDs in the baseline period, AECOPD number and severity were associated with increased long-term risk of both MI and PE in a gradual fashion, ranging from a subdistribution hazard ratio of 1.10 (95%CI, 0.97-1.24) and 1.33 (95%CI, 1.11-1.60), respectively, for one moderate exacerbation, to 1.82 (95%CI, 1.36-2.44) and 2.62 (95%CI, 1.77-3.89), respectively, for two or more severe exacerbations. In a time-restricted follow-up sensitivity analysis, the associations were stronger during the first year of follow-up and diminished over time. The risk of MI and PE increases with the frequency and severity of AECOPD in this large, real-life cohort of patients with COPD.

Healthcare resource utilization in patients with pulmonary hypertension associated with chronic obstructive pulmonary disease (PH-COPD): a real-world data analysis

RationaleThere is a lack of real-world characterization of healthcare costs and associated cost drivers in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (PH-COPD).ObjectivesTo examine (1) excess healthcare resource utilization (HCRU) and associated costs in patients with PH-COPD compared to COPD patients without PH; and (2) patient characteristics that are associated with higher healthcare costs in patients with PH-COPD.MethodsThis study analyzed data from the IQVIA PharMetrics® Plus database (OCT2014-MAY2020). Patients with PH-COPD were identified by a claims-based algorithm based on PH diagnosis (ICD-10-CM: I27.0, I27.2, I27.20, I27.21, I27.23) after COPD diagnosis. Patients aged ≥40 years and with data available ≥12 months before (baseline) and ≥6 months after (follow-up) the first observed PH diagnosis were included. Patients with other non-asthma chronic pulmonary diseases, PH associated with other causes, cancer, left-sided heart failure (HF), PH before the first observed COPD diagnosis, or right-sided/unspecified HF during baseline were excluded. Patients in the PH-COPD cohort were matched 1:1 to COPD patients without PH based on propensity scores derived from baseline patient characteristics. Annualized all-cause and COPD/PH-related (indicated by a primary diagnosis of COPD or PH) HCRU and costs during follow-up were compared between the matched cohorts. Baseline patient characteristics associated with higher total costs were examined in a generalized linear model in the PH-COPD cohort.ResultsA total of 2,224 patients with PH-COPD were identified and matched to COPD patients without PH. Patients with PH-COPD had higher all-cause HCRU and annual healthcare costs ($51,435 vs. $18,412, p<0.001) than matched COPD patients without PH. Among patients with PH-COPD, costs were primarily driven by hospitalizations (57%), while COPD/PH-related costs accounted for 13% of all-cause costs. Having a higher comorbidity burden and a prior history of COPD exacerbation were major risk factors for higher total all-cause costs among patients with PH-COPD. ConclusionsTreatment strategies focusing on preventing hospitalizations and managing comorbidities may help reduce the burden of PH-COPD.

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.

Chronic obstructive pulmonary disease and comorbid psychiatric disorders: preliminary results of an 8-year retrospective study using real data

IntroductionChronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. In Portugal, it is estimated to afflict 14.2% of the population over the age of 45 and is one of the most common causes of morbidity, with a significant social impact and excessive expenses. Moreover, COPD is associated with high levels of psychological distress and diverse psychiatric disorders that heighten the disease burden as they are associated with increased risk of exacerbations and frequent hospitalizations. Despite this overview, psychiatric conditions remain understudied compared to comorbid general medical conditions, and few studies have assessed their effect on COPD hospitalization outcomes.ObjectivesThis study aimed to describe the occurrence of a vast array of psychiatric comorbid diagnoses in COPD hospitalizations and to understand their impact on hospitalization outcomes.MethodsA retrospective observational study was conducted. All inpatient episodes from 2008 to 2015 of patients with at least 40 years and a primary diagnosis of COPD (ICD-9-CM codes 491.x, 492.x and 496) were selected from a national administrative database that included all hospitalizations in mainland public hospitals. From these sampled episodes, secondary psychiatric diagnoses were identified (ICD-9-CM codes 290.x-319.x). Age at hospitalization, sex, psychiatric comorbidities, length of stay (LoS) in days, admission type and date, destination after discharge, in-hospital mortality and hospital charges were analyzed.ResultsFrom a total of 66,661 COPD hospitalizations, 17,652 (26.5%) corresponded to episodes with a secondary psychiatric diagnosis. Patients with a comorbid psychiatric diagnosis were on average younger at admission (70.3 vs. 75.9 years, p&lt;0.001), had a longer median LoS (9.89 vs. 9.33 days, p&lt;0.001) and higher urgent admission rates (96.2% vs. 95.7%, p=0.009). There was also a significant association between discharge destination and psychiatric diagnoses (p&lt;0.001).ConclusionsThese findings suggest that mental disorders have an adverse and quantifiable impact on COPD hospitalization outcomes. With this in mind, to provide optimal treatment for patients with both conditions, psychiatric disorders should become a matter of routine evaluation and follow-up.Disclosure of InterestNone Declared

The impact of pulmonary cachexia on inpatient outcomes: A national study.

Cachexia has been associated with chronic lung disease (pulmonary cachexia syndrome), which is associated with increased mortality. However, studies that looked into this association was relatively small, and national level data are lacking. Herein, we aim to study the association between chronic obstructive lung disease (COPD) and cachexia. Do patients with COPD and cachexia has worse inpatient outcomes in comparison to those with no cachexia? We used the Nationwide Readmissions Database from 2016 to 2019, extracting adult patients with a primary diagnosis of COPD who were admitted between January and November of each year studied. We excluded patients with missing data on event time or length of stay. Furthermore, we excluded all cases with cormobidities associated with cachexia. We used SAS 9.4 for data exploration and analysis. We included 1,446,431 COPD-related weighted hospitalizations for which 115,276 cases (7.9%) had a concurrent diagnosis of cachexia (or cachexia-related diagnoses). Overall, patients with cachexia (COPD-C), compared to patients with COPD and no cachexia (COPD-NC), were older (mean age 69 vs. 66 years, respectively, P < 0.001) with similar gender distribution (58%). COPD-C patients had more inpatient complications including cardiac arrest, and use of mechanical ventilation (P < 0.001). Furthermore, they had longer mean lengths of stay (5.2 days vs. 3.8 days, P < 0.001). In-hospital mortality during index, admission was significantly higher in these patients at 2.2% compared to 0.5% for COPD-NC (P < 0.001). COPD-related cachexia is associated with increased inpatient mortality, resource utilization, and prolonged hospitalization.

Intermittent prophylactic antibiotics for bronchiectasis.

Intermittent prophylactic antibiotics for bronchiectasis.

Measuring the impact of a Chronic Obstructive Pulmonary Disease Community Respiratory Programme on emergency admissions to hospital: a controlled interrupted time series analysis.

A community respiratory service was implemented in the North West of Glasgow (NW) in January 2013, as part of the Reshaping Care for Older People programme (RCOP). This study aimed to measure the impact of the service on older people's emergency admissions (EAs) to hospital. EAs to hospital with a primary diagnosis of COPD (COPD EAs) per 1,000 population aged 65years+ in NW were compared before and after onset of the service with a 6-month phase-in period, using segmented linear regression. South and North East Glasgow (S + NE) was the control-an area with no such service in place. The model adjusted for the rate of all-cause EAs to control for the impact of other localised RCOPP initiatives. Autoregressive terms and a Fourier term to adjust for seasonality were included in the model. Prior to implementation of the respiratory service, increases in COPD EAs over time were evident in NW. Adjusting for changes in COPD EAs in NE + S, an additional reduction of -0.04 (-0.03, -0.05) per 1,000 population per month was observed in NW following the phase-in, so that by March 2015, the predicted reduction due to the respiratory service was -0.85 COPD EAs per 1,000 population, a relative reduction of 34.3%. No significant changes in admissions with COPD as a secondary diagnosis (COPD5 EAs) were observed, suggesting that the intervention had no impact on these. The community respiratory service was associated with a significant reduction in the rate of COPD EAs among older people and no change in COPD5 EAs.

Alcohol use disorder and healthcare utilization in patients with chronic asthma and obstructive lung disease.

Alcohol use disorder (AUD) is associated with significant direct morbidity and mortality. The impact of alcohol on chronic asthma and obstructive lung disease is unknown. AUD treatment may represent a potential target to improve healthcare utilization and healthcare costs in this patient population. Utilizing data from the 2012-2015 Nationwide Readmissions Database (NRD) and Nationwide Emergency Department Sample (NEDS), patients with a primary admission diagnosis of asthma or COPD were identified. Documented substance misuse, rates of hospitalization, frequency of hospital readmission, markers of admission severity, and cost were assessed. Within the NEDS cohort, 2,048,380 patients with a diagnosis of COPD or asthma were identified. Patients with documented AUD were more likely to present with respiratory failure [OR 1.32 (1.26, 1.39); p<0.001] and more likely to require mechanical ventilation in the emergency room [OR 1.30 (1.19, 1.42); p<0.001]. Within the NRD cohort, 1,096,663 hospital admissions were identified, of which 4.1% had documented AUD. AUD was associated with an increased length of stay [percentage increase estimate: 5% (4,6); p<0.001], increased hospitalization cost, and an increased likelihood of 30-day readmission in patients with a primary admission diagnosis of COPD or asthma [OR 1.24 (1.2, 1.28); p<0.001]. AUD is associated with increased disease morbidity and healthcare utilization in patients admitted with asthma or COPD. This impact persists after adjusting for substance misuse and associated comorbidities. Identifying and treating AUD in this patient population may improve disease, patient, and health-system outcomes.

Clinical, laboratory, and functional characteristics of asthma-COPD overlap in patients with a primary diagnosis of COPD.

ABSTRACTObjective:To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. Methods:The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. Results:Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). Conclusions:In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.

Impact of a community respiratory service on emergency hospital admissions

Abstract Background A community respiratory service was implemented in the North West of Glasgow in January 2013, comprising a team of physiotherapists, occupational therapists and support workers, to provide education, self-management advice, and, where appropriate, treatment at home, for COPD patients, to reduce the risk of hospital admission. This study measures the impact of the service on emergency admission to hospital. Methods COPD EAs were defined as emergency admissions to hospital with a primary diagnosis of COPD. Rate of COPD EAs per 1000 population aged 65 years+ in Glasgow City was compared before and after onset of the service, using segmented linear regression with 21-month pre- and 17-month post-intervention periods. COPD EAs for residents of South and North East Glasgow (S+NE) - areas with no such service in place - were used as a comparison group. The model adjusted for the rate of all-cause emergency admissions. Autoregressive terms were included in the model, as well as a fourier term to adjust for seasonality. Models were similarly run for outcome emergency admissions with COPD in any of the other five fields of diagnosis. Results Adjusting for all cause EAs and changes in S+NE, thus factoring out the impact of other initiatives that may have affected emergency admission to hospital, the impact of the service was found to be a level change of -0.33 (-0.51, -0.16) and a trend change of -0.03 (-0.05, -0.02) COPD EAs per 1000 per month. This is equivalent to a predicted reduction due to the service of -0.88 COPD EAs per 1000 popn per month, in March 2015, and a relative reduction of 35.8%. Rate of COPD EAs per month reduced over time after the introduction of the service (from the point of full staffing). Rate of EAs with COPD in a field of diagnosis other than primary saw no significant change in level or trend associated with the service. Conclusions The community respiratory service was associated with a significant reduction in the rate of COPD EAs. Key messages The Community Respiratory service was associated with reductions in emergency hospital admissions with COPD as a primary diagnosis. There was no significant change in emergency admissions with COPD as a secondary diagnosis, suggesting hospital attendance for patients with COPD overall reduced following the intervention.

What Happens to Frailty in the First Year after Lung Transplantation?

Purpose Frailty is prevalent in lung transplant (LTX) candidates. Frailty can be associated with death before and after LTX, it is unclear if frailty trajectory persists for the first year. The study aimed to investigate frailty over the first year of LTX. Methods LTX candidates aged over 18 years were consented at listing time. All post LTX recipients completed thrice weekly, 12 week exercise rehabilitation program consisting of cardiovascular training on bike and treadmill and upper and lower limb strength training. Clinical data was collected. Edmonton frail scale (EFS) was used to assess frailty. Grip strength was also tested. Primary outcome was 6minute walk distance (6MWD) measured at 4 time-points: pre LTX, pre-rehabilitation, post-rehabilitation and 1 year. Results Of 103 participants, 90 (87%) were transplanted. Mean age was 58±11 yrs, 48 % were male, 52% had primary diagnosis of COPD. Frailty scores pre LTX were mean 5.54 ± 2.4 and at one year mean 3.28 ±1.5. Amongst all participants, 6WMD improved significantly over time: pre-rehabilitation (mean 326m) compared to post-rehabilitation (mean 523m (p 8 had shorter 6MWD preLTX compared to those with EFS ≤ 8 (245m vs. 305m, p=0.085) and similarly at pre-rehabilitation (277m vs. 331m, p=0.077). There were no differences in 6MWD comparing EFS > 8 vs ≤ 8 post-rehabilitation (523m vs. 520m, p=0.93) or at 1 year (497m vs. 510m, p=0.80). Participants with poorer EFS functional performance domain had shorter 6MWD pre LTX and pre-rehabilitation, but this difference disappeared by 1 year. Those with baseline grip strength Conclusion Participants in a structured post-LTX rehabilitation program improved in functional exercise capacity (6MWD). The program improves 6MWD in frail patients to a point comparable to less frail patients, with poor pre-rehabilitation functional capacity being successfully managed during the program. Grip strength may serve as an important predictor of the trajectory of improvement.

Prevalence of Atrial Fibrillation in Hospital Encounters With End-Stage COPD on Home Oxygen: National Trends in the United States

This study aimed to evaluate the prevalence of atrial fibrillation (AF) in hospital encounters with end-stage COPD on home oxygen admitted for COPD exacerbation. We used the 2003 to 2014 Nationwide Inpatient Sample to conduct a retrospective analysis. This study included all patients≥ 18 years of age with a primary diagnosis of COPD on home oxygen who were hospitalized for COPD exacerbation. We used multivariate-adjusted models to evaluate the association of AF with clinical factors, cost, length of stay, and hospital outcomes. In total, 1,345,270 patients were included; of these, 244,488 (18.2%) had AF. The AF prevalence increased from 12.9%in 2003 to 21.3%in 2014 (P< .0001) and varied by age, sex, race, income, insurance type, and hospital region. Advancing age, female sex, white race, high income, and large hospital size were associated with increased odds of AF. Presence of AF was a risk predictor for in-hospital death (OR, 1.54; 95%CI, 1.45-1.65), acute respiratory failure (OR, 1.09; 95%CI, 1.06-1.12), invasive mechanical ventilation (OR, 1.37; 95%CI, 1.29-1.47), noninvasive mechanical ventilation (OR, 1.14; 95%CI, 1.09-1.18), acute kidney injury (OR, 1.09; 95%CI, 1.04-1.13), sepsis (OR, 1.23; 95%CI, 1.10-1.37), and stroke (OR, 1.80; 95%CI, 1.40-2.32). AF was also associated with increased cost and length of stay. AF prevalence in hospital encounters with end-stage COPD increased from 2003 to 2014. Better management strategies for patients with end-stage COPD comorbid with AF are needed, especially in elderly individuals.

EFFECT OF OPIOID ABUSE AND DEPENDANCE ON OUTCOMES OF PATIENTS HOSPITALIZED WITH COPD: A 5-YEAR ANALYSIS

SESSION TITLE: Obstructive Lung Diseases 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Use of opioids is prevalent in patients with COPD which raises concern about potential respiratory complications in this population. The aim of this study is to analyze the outcomes of patients admitted for COPD or COPD exacerbation with a history of opioid abuse or dependence. METHODS: This is a retrospective propensity score matched analysis utilizing the 2010 to 2014 Nationwide Inpatient Sample, the largest inpatient database in the United States. The study population comprised of 23,074 patients over age 18 with a primary diagnosis of COPD or COPD exacerbation with and without a secondary diagnosis of opioid abuse or dependence. The outcomes of interest were mortality, non-invasive ventilation (NIV) use, endotracheal intubation and length of stay. Multivariate logistic regression was performed to test for independent associations between variables of interest. Diagnoses and procedures were identified using ICD-9-CM codes. Analysis was performed using STATA 14.2. RESULTS: Patients in the opioid group were more likely to be intubated during hospitalization when compared to non-opioid users (OR 1.68, p<0.05). However, no difference in mortality was seen (OR 0.53, p=0.182). NIV utilization did not differ among the groups (OR 1.05 p=0.67) and no difference in length of stay was found (additional 0.042 days, p=0.3). CONCLUSIONS: Opioid dependence and abuse increase the risk of intubation in patients hospitalized for COPD but did not affect mortality. No differences were seen in NIV utilization or length of stay. Further research is needed to better understand the role of chronic opioid use and abuse in patients admitted for COPD. CLINICAL IMPLICATIONS: Clinicians should be aware of the potential adverse respiratory outcomes of opioid dependance or abuse in patients who are hospitalized for COPD related complications. DISCLOSURES: No relevant relationships by Felipe Bolivar Rincon, source=Web Response No relevant relationships by Joseph Mathew, source=Web Response No relevant relationships by Christian Olivo Freites, source=Web Response No relevant relationships by Di Pan, source=Web Response No relevant relationships by Sathish Pondaiah, source=Web Response No relevant relationships by Fernando Vazquez de Lara, source=Web Response

COPD Patients with Acute Exacerbation Who Developed Refeeding Syndrome during Hospitalization Had Poor Outcome: A Retrospective Cohort Study

Summary Background The study retrospectively investigated risk factors for refeeding syndrome in COPD patients with acute exacerbation and its impact on clinical outcomes. Methods We retrospectively reviewed discharge notes of patients with primary diagnosis of COPD with acute exacerbation from August 2014 to December 2015. Demographic data, BMI, the last post-bronchodilator FEV 1 , case-mixed index (CMI), APACHE-II score, average daily total energy intake (TEI) and adjusted by current BW to obtain average daily total energy intake index (TEII) of the first four hospitalization days, the initial ABG with calculated P a O 2 /F i O 2 were collected. Laboratory RFS was arbitrarily defined as either serum P or Mg declined 15% or more after feeding in comparison with the pre-feeding one and fell below the lower limit of normal ranges. Results 61 patients were eligible for analysis and 38% had RFS. Univariate analyses showed that advanced age, low BMI, high TEII, low post-bronchodilator FEV 1 , high APACHE-II score, low P a O 2 /F i O 2 , high P a CO 2 , low pH, and leukocytosis at admission were risk factors for RFS. However, multiple logistic regression revealed that only BMI, TEII and the last post-bronchodilator FEV 1 were the risk predictors for RFS. Those who developed RFS had high risk to suffer from delirium, be intubated and receive invasive mechanical ventilation with difficult weaning from the ventilator, and have longer LOS. No in-hospital mortality was found. Conclusion RFS should not be overlooked in COPD patients with acute exacerbation. Awareness of this feeding-related complication is mandatory for early diagnosis and appropriate management to prevent morbidity and mortality.

A Comparison Between Pulmonary Function Tests and Disease Impact With Exertional Oxygen Desaturation in Patients With COPD

SESSION TITLE: Airways 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Exertional desaturation (ED) is associated with increased mortality and deleterious cardiopulmonary effects in patients with COPD. While O2 therapy during exercise has not shown a mortality benefit, it has shown to significantly boost health-related quality of life measures. The current study aims to compare the incidence of ED, its correlation with pulmonary function tests (PFTs), and its association with patient-rated disease impact as per the St. George’s Respiratory Questionnaire (SGRQ) in patients with COPD. METHODS: A retrospective chart review of 233 patients was performed in the pulmonary rehabilitation center of a major urban medical center. 105 patients were identified with primary diagnosis of COPD, not on home oxygen. PFTs were performed within 6 months of enrollment; SGRQs were completed during intake, and all patients underwent standard 6 Minute Walk Tests (6MWTs) with SaO2 recorded by pulse oximeter. A drop in SaO2 of ≥4% or SaO2 <90% was defined as ED. Analysis groups were divided into GOLD Stage I-II and III-IV, and DLCO >50% and <50%. RESULTS: In Stage I-II, 65.22% and 74.58% in Stage III-IV experienced ED (p=0.149), compared to 65.79% and 87.80% in the >50% and <50% DLCO groups (p=<0.01). DLCO had a significant inverse correlation with ED (r=-0.28; p=<0.01), while FEV1 (r=-0.04; p=0.32), and FEV1/FVC (r=-0.1; p=0.15) did not. Degree of heart rate elevation during 6MWTs showed a significant correlation with degree of ED (r=+0.23; p=<0.01). Resting SaO2 did not show a significant correlation with ED (r=+0.15; p=0.69). Stage III-IV patients endorsed significantly more symptoms (p=<0.01), more social impairment (p=0.01) and higher overall disease impact (p=<0.01) compared to Stage I-II on SGRQ, but not higher limitations in activity (p=0.18). <50% DLCO patients endorsed significantly more symptoms (p=<0.01), higher limitations in activity (p=0.04), more social impairment (p=0.02) and higher overall disease impact (p=<0.01) compared to >50% DLCO patients on SGRQ. CONCLUSIONS: Decreased DLCO may predict risk of ED in patients with COPD better than FEV1 or resting SaO2. Degree of elevation from baseline heart rate during exertion may signify risk for ED. While Stage III-IV patients endorsed more overall disease impact than Stage I-II, stratification by >50% or <50% DLCO performed better in highlighting limitations in activity. CLINICAL IMPLICATIONS: DLCO should be included in all PFTs performed in patients with COPD, and a diffusion capacity of <50% should prompt an evaluation for ED. DISCLOSURE: The following authors have nothing to disclose: Marjan Islam, Matthew Frank, Ted Marks, Corinne Rey, Jonathan Raskin No Product/Research Disclosure Information

Impact of an Electronic Medical Record Screening Tool and Therapist-Driven Protocol on Length of Stay and Hospital Readmission for COPD.

In the United States, care for COPD patients is frequently delivered by respiratory therapists (RTs). After implementing a therapist-driven protocol for COPD treatment, we sought to improve identification of COPD patients. We hypothesized that using an electronic medical record screening tool to identify subjects with COPD combined with a therapist-driven protocol would positively impact length of stay (LOS) and readmission rates. Utilizing the electronic medical record to search the provider's admission notes for the terms COPD/Asthma, a report was generated. Subjects already receiving RT services were removed. An RT evaluated identified subjects using a therapist-driven protocol combining clinical assessment and FEV1 to calculate an air-flow obstruction score. Scores ≥7 received 24 h of bronchodilator therapy by RTs. Scores <7 received assessment by RTs but bronchodilator therapy administered by nursing staff. An RT performed medication reconciliation and education for both groups. ICD-9 discharge codes identified primary and secondary diagnoses of COPD. LOS and 30-d readmission rates were measured for a 14-month period. Respiratory-triggered rapid response data were also collected. The pre-intervention period was from December 2013 to June 2014, and the post-intervention period was from July 2014 to January 2015. There were 142 subjects in total, 68 pre-intervention and 74 post-intervention. For primary COPD, mean LOS decreased from 4.37 to 2.96 d (P = .10), and 30-d readmission rates decreased from 13.6 to 6.1%. Respiratory-triggered rapid response data were as follows: The pre-intervention span was from January 2014 to June 2014, and post-intervention was from July 2014 to December 2015. For primary COPD, there were 61 pre-intervention subjects and 63 post-intervention with a decrease in respiratory-triggered rapid responses from 21 pre-intervention (34.4%) to 8 post-intervention (12.7%) (P = .004). For secondary COPD (1,168 pre-intervention, 1,267 post-intervention), there was a change from 318 (27.2%) pre-intervention to 296 (23.4%) post-intervention (P = .03). Utilization of the electronic medical record to identify subjects with likely COPD combined with a therapist-driven protocol directed by RT assessment was associated with a trend toward decreased LOS and reduction in readmission rates. There was a significant reduction of respiratory-triggered rapid responses in subjects with a primary diagnosis of COPD.

Effect of Hospital Use of Oral Nutritional Supplementation on Length of Stay, Hospital Cost, and 30-Day Readmissions Among Medicare Patients With COPD

COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplementation (ONS) has been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. Using the Premier Research Database, we first identified Medicare patients aged ≥ 65 years hospitalized with a primary diagnosis of COPD. We then identified hospitalizations in which ONS was provided, and used propensity-score matching to compare LOS, hospitalization cost, and 30-day readmission rates in a one-to-one matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also used instrumental variables analysis to study the association of ONS with study outcomes. Model covariates included patient and provider characteristics and a time trend. Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N = 14,326). In unadjusted comparisons in the matched sample, ONS use was associated with longer LOS (8.7 days vs 6.9 days, P < .0001), higher hospitalization cost ($14,223 vs $9,340, P < .0001), and lower readmission rates (24.8% vs 26.6%, P = .0116). However, in instrumental variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (P < .01); a hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (P < .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (P < .01). ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD.

S70 Implementing a COPD discharge bundle on a large scale

IntroductionThere is emerging interest in the delivery of discharge care bundles to manage patients admitted with an an exacerbation of a chronic disease. This approach has been tested on a...

P174 Reduction in hospital admissions in COPD patients following domiciliary BIPAP

IntroductionCOPD is a condition with multiple implications to the sufferer in terms of disability and high mortality, and one that often necessitates multiple hospital admissions, resulting in further distress to...

S67 COPD–in the NEWS!

NICE1 recommends ‘track and trigger’ systems for all adult acute hospital admissions and the RCP2 advocates the use of the National Early Warning Score (NEWS) to promptly highlight high risk...