Exacerbations of chronic obstructive pulmonary disease

Abstract

To describe the characteristics of patients visiting a Hospital Emergency Department (HED) due to chronic obstructive pulmonary disease (COPD) exacerbation (AECOPD) and to evaluate their management.A cross-sectional study of the first 219 patients with AECOPD visiting the HED of the University Hospital Arnau de Vilanova, Lleida, Spain, was performed from January to May 2016. The data collected included the following: main patient characteristics, diagnostic tests, applied treatments, response times, discharge destination, need for hospital admission, and re-admissions and deaths at 90 days. Comparisons were made according to sex and need for hospitalization.The patients consisted of 84% men, with a mean age (standard deviation [SD]) of 75.9 (11) years and a FEV1/FVC of 56 (13)%; 63% were ex-smokers. The median time (P25–P75) in the HED was 6 (4–10) hours, with shorter waiting times for severe patients. Additionally, 74% of patients required hospital admission. The percentages of re-admissions and mortality at 90 days were 25% and 14%, respectively. Among female patients, 63% never consumed tobacco, and the most frequent clinical phenotype was asthma combined with COPD; female patients visited the family doctor sooner after AECOPD than men (4 vs 7 days). Overall, the following areas of improvement were identified: use of sputum culture (performed in 3% of patients); documentation of variables; patient care times; and reduction in the time until first medical check-up.The overall quality of care provided to AECOPD patients was satisfactory and consistent with current clinical guidelines. Nevertheless, improving the quality of care at the HED requires establishing protocols that ensure that the necessary diagnostic tests are performed, optimize response times and guarantee that all relevant information is collected.

Trends in Hospital Admissions for Chronic Obstructive Pulmonary Disease in Men and Women in Spain, 1998 to 2018

“…In another study, this time in Canada, 60.1% of patients admitted for COPD were men, but there were no gender-related differences in the rate of readmissions [ 10 ]. In a Spanish hospital, Abadías Medrano et al [ 11 ] followed 216 patients who presented to the emergency department (ED) for a COPD exacerbation in May and June 2016; 84% were men, although there was no difference according to gender in the proportion who were admitted. Compared to men, women were less likely to be smokers (9% vs. 63%), more likely to present with the asthma/COPD phenotype (48% vs. 11%), and earlier to see their doctor following discharge (4 days versus 7 days), with no gender differences with regard to history of COPD exacerbations over the previous year.…”

“…Compared to men, women were less likely to be smokers (9% vs. 63%), more likely to present with the asthma/COPD phenotype (48% vs. 11%), and earlier to see their doctor following discharge (4 days versus 7 days), with no gender differences with regard to history of COPD exacerbations over the previous year. Men were at greater risk for readmission at 90 days (8.2% versus 4.7%) [ 11 ]. A recent systematic review of COPD [ 12 ] exacerbations in international clinical trials, which included 55 studies, found a 6.7% (95% CI 4.4, 9.0; p < 0.001) annual decrease in admissions from 1997 to 2017, equivalent to a 50% (95% CI 36%, 61%) decrease over a decade.…”

Characteristics, Management and In-Hospital Clinical Outcomes Among Inpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in China: Results from the Phase I Data of ACURE Study

“… 26 Although the rate and amount of smoking among patients hospitalized with AECOPD were high, they were lower compared to those in some other countries (rate ranges: 82%–96%, average amount ranges: 40–56 pack-years). 13 , 14 , 27 , 28 Smokers often demonstrate more severe symptoms, such as dyspnea and cough, than non-smokers. 29 And the dose-response relationship between tobacco consumption and severity of COPD has been established worldwide.…”

“…There were a few studies exploring characteristics, healthcare resource usages and clinical outcomes among AECOPD patients. [12][13][14][15][16][17] However, results varied across countries. To our knowledge, there is still a lack of studies on this topic in China with large sample sizes in real-world setting.…”

Incidence of delirium following hospitalization of elderly people with fractures: risk factors and mortality

“…Elderly people with COPD also had a higher risk of delirium in this study. A study demonstrated that elderly people hospitalized with COPD more frequently have: recurrent infections, low respiratory infections, hydroelectrolytic disorders, associated cardiac diseases, ventilatory support, longer ICU stays (23) . The combination of these factors can contribute to complications, one of them being delirium (23) .…”