Xavier Pomares1,2,3, Concepción Montón1,4, Marisa Baré5,6,4, Marina Pont5,4, Cristina Estirado7, Joaquim Gea7,3, José Maria Quintana8,4, Silvia Vidal9, Ana Santiago10. 1. a Department of Respiratory Medicine , Parc Taulí Sabadell - University Hospital , Sabadell , Spain. 2. b Universitat Autònoma de Barcelona , Esfera UAB , Barcelona , Spain. 3. j Multidisciplinary and Multi-Institutional Research Network in Respiratory Diseases-CIBERES, Instituto de Salud Carlos III (ISCIII) , Spain. 4. i Health Services Research on Chronic Diseases Network- REDISSEC , Spain. 5. c Clinical Epidemiology , Parc Taulí Sabadell - University Hospital , Sabadell , Spain. 6. d Obstetrics, Gynecology and Preventive Medicine Department , Universitat Autònoma de Barcelona-UAB, Bellaterra , Barcelona , Spain. 7. e Pulmonology Department, Hospital del Mar - IMIM. CEXS , Universitat Pompeu Fabra , Barcelona , Catalonia , Spain. 8. f Research Unit, Galdakao Hospital , Bilbao , Spain. 9. g Research Unit, Hospital Costa del Sol , Marbella , Spain. 10. h Pulmonology Department. Hospital , La Paz . Madrid , Spain.
Abstract
BACKGROUND: The impact of hospital emergency care and inward admission for acute exacerbations of COPD on inhaled maintenance treatment is not well known. OBJECTIVE: Therefore, we evaluated the impact of short-stay emergency hospital care and inward admission for acute exacerbation of COPD (eCOPD) on inhaled maintenance treatment prescribed at discharge. DESIGN: Prospective observational cohort study of patients presenting with eCOPD at emergency departments in 16 hospitals of the Spanish healthcare system. The ethics committee at each hospital approved the study and patients provided an informed consent before inclusion. We classified the patients according to the severity of COPD: mild/moderate (FEV1 ≥ 50% predicted) or severe/very severe (FEV1 < 50% predicted) and need of inward hospitalisation. We analysed changes to maintenance treatment on discharge according to GOLD strategy. RESULTS: 1559 patients, 65% required hospitalisation. The most common maintenance treatment was inhaled corticoids (ICS) (80.9%) followed by long-acting beta-agonists (LABA) (75.4%). The most common combination was triple therapy (LABA+ LAMA+ICS) (56.2%) followed by LABA+ICS dual therapy (18.2%) regardless of the severity of COPD. In more than 60% of patients treatment was not changed at discharge. The most common change in treatment was a reduction when discharge was from emergency care and an increase after hospitalisation (-21.6% and +19.5% in severe/very severe COPD, respectively). CONCLUSIONS: Emergency hospital care for eCOPD does not usually induce changes in inhaled maintenance treatment for COPD regardless of the duration of the hospital stay.
BACKGROUND: The impact of hospital emergency care and inward admission for acute exacerbations of COPD on inhaled maintenance treatment is not well known. OBJECTIVE: Therefore, we evaluated the impact of short-stay emergency hospital care and inward admission for acute exacerbation of COPD (eCOPD) on inhaled maintenance treatment prescribed at discharge. DESIGN: Prospective observational cohort study of patients presenting with eCOPD at emergency departments in 16 hospitals of the Spanish healthcare system. The ethics committee at each hospital approved the study and patients provided an informed consent before inclusion. We classified the patients according to the severity of COPD: mild/moderate (FEV1 ≥ 50% predicted) or severe/very severe (FEV1 < 50% predicted) and need of inward hospitalisation. We analysed changes to maintenance treatment on discharge according to GOLD strategy. RESULTS: 1559 patients, 65% required hospitalisation. The most common maintenance treatment was inhaled corticoids (ICS) (80.9%) followed by long-acting beta-agonists (LABA) (75.4%). The most common combination was triple therapy (LABA+ LAMA+ICS) (56.2%) followed by LABA+ICS dual therapy (18.2%) regardless of the severity of COPD. In more than 60% of patients treatment was not changed at discharge. The most common change in treatment was a reduction when discharge was from emergency care and an increase after hospitalisation (-21.6% and +19.5% in severe/very severe COPD, respectively). CONCLUSIONS: Emergency hospital care for eCOPD does not usually induce changes in inhaled maintenance treatment for COPD regardless of the duration of the hospital stay.
Entities:
Keywords:
clinical practice; inward admission; quality of care; triple therapy
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