Emergency Hospital Care for Exacerbation of COPD: Is Inhaled Maintenance Therapy Modified?

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.

Keywords:

• clinical practice
• inward admission
• quality of care
• triple therapy

Acknowledgments

We are grateful for the support of the 16 participating hospitals, as well as the members of the various services, research, quality units, and medical records sections of these hospitals. We also gratefully acknowledge the patients who participated in the study.

The authors also acknowledge the detailed review of the manuscript by Dr. Eduard Monsó and the editorial assistance provided by John Giba.

Funding

This work was supported in part by grants from the Fondo de Investigación Sanitaria (PI06\1010, PI06\1017, PI06\714, PI06\0326, PI06\0664); and the thematic networks- Red IRYSS (Investigación en Resultados y Servicios Sanitarios (G03\220) and REDISSEC (Health Services Research on Chronic Diseases Network; RD12/0001/0007) – of the Instituto de Salud Carlos III.

Declaration of Interest Statement

The authors report no conflicts of interest in this study. The authors alone are responsible for the content and writing of the paper. XP, CM, and MB designed the study, participated in the acquisition of data, interpreted the results, drafted the manuscript, and approved its final version. JG interpreted the results and reviewed the manuscript for intellectual content. JMQ conceived and coordinated the main study CE, SV and AS, participated in the acquisition of data. MP supported the statistical analysis. All authors critically reviewed the manuscript. All of them read and approved the final manuscript.

Competing Interests

Members of the IRYSS-COPD Group

The IRYSS-COPD group included the following co-investigators: Dr. Jesús Martínez-Tapias (Dirección Económica, Área Gestión Sanitaria Sur Granada); Alba Ruiz (Hospital de Motril, Granada); Dr. Eduardo Briones (Epidemiology Unit, Primary Care, Sevilla); Dr. Emilio Perea-Milla, Francisco Rivas and Dr. Silvia Vidal (Servicio de Epidemiología, Hospital Costa del Sol, Málaga – REDISSEC); Dr. Maximino Redondo (Servicio de Laboratorio, Hospital Costa del Sol, Málaga- REDISSEC); Javier Rodríguez Ruiz (Responsable de Enfermería del Área de Urgencias, Hospital Costa del Sol, Málaga); Dr. Marisa Baré, Núria Torà (Clinical Epidemiology, Parc Taulí Sabadell-UAB and REDISSEC), Dr. Gemma Navarro (Epidemiology, Parc Taulí); Dr. Concepción Montón (Pneumology Service, Parc Tauli and REDISSEC); Dr. Manel Lujan, Dr. Amalia Moreno, Dr. Josune Ormaza, Dr. Xavier Pomares (Pulmonology Service, Parc Taulí); Dr. Juli Font (Medicine and Emergency Department; Parc Taulí), Dr. Cristina Estirado, Dr. Joaquim Gea (Pulmonology Department, Hospital del Mar. CEX, UPF. CIBERES. Barcelona); Dr. Juan Antonio Blasco, Dr. Nerea Fernández de Larrea (Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, Madrid); Dr. Ana Santiago, Dr. Ana Martínez-Virto (Pulmonology and Emergency Department, Hospital La Paz, Madrid); Dr. Esther Pulido (Servicio de Urgencias, Hospital Galdakao-Usansolo, Bizkaia); Dr. Jose Luis Lobo (Servicio de Neumología, Hospital Txagorritxu, Araba); Dr. Mikel Sánchez (Servicio de Urgencias, Hospital Galdakao-Usansolo, Bizkaia); Dr. Luis Alberto Ruiz (Servicio de Respiratorio, Hospital Cruces, Bizkaia); Dr. Ane Miren Gastaminza (Hospital San Eloy, Bizkaia); Dr. Ramon Agüero (Servicio de Neumología, Hospital Marqués de Valdecilla, Santander); Dr. Gabriel Gutiérrez (Servicio de Urgencias, Hospital Cruces, Bizkaia); Dr. Belén Elizalde (Dirección Territorial de Gipuzkoa); Dr. Felipe Aizpuru (Unidad de Investigación, Hospital Txagorritxu, Álava/REDISSEC); Dr. Inmaculada Arostegui (Departamento de Matemática Aplicada, Estadística e Investigación Operativa, UPV- REDISSEC); Amaia Bilbao (Hospital de Basurto-REDISSEC); Dr. Eva Tabernero and Carmen M. Haro (Hospital de Santa Marina); Dr. Cristóbal Esteban (Servicio de Neumología, Hospital Galdakao-Usansolo-REDISSEC, Bizkaia); Dr. Nerea González, Susana García, Iratxe Lafuente, Urko Aguirre, Irantzu Barrio; Miren Orive, Edurne Arteta, Dr. Jose M. Quintana (Unidad de Investigación, Hospital Galdakao-Usansolo, Bizkaia / REDISSEC).