Comprehensive Care Management in Conjunction with Sputum Cytometry-Guided Pharmacotherapy in a Post-Discharge Clinic for Patients with COPD

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are amongst the most common reasons for hospital admission, and recurrent episodes occur frequently. Comprehensive care management (CCM) strategies have modest effect in preventing re-admissions. The objectives of this study were to examine the utility of optimizing anti-inflammatory therapy guided by sputum cytometry in the post-hospitalization setting, and to assess the feasibility and effectiveness of a clinic combining CCM and sputum-guided therapy. This is an observational study examining patients who received open-label CCM and sputum cytometry-guided pharmacotherapy in a COPD post-discharge clinic. Referral was based on high risk for readmission after hospitalization for AECOPD. The primary outcome was the change in COPD-related healthcare utilization before and after Visit 1, and this was analyzed with a mixed-effects negative binomial model controlling for age, number of follow-up clinic visits, pack years, current smoking and FEV₁. Of 138 patients referred to the clinic, 73% attended at least one visit. Mean FEV₁ was 42.8 (19.3) % predicted. Of the patients attending clinic, 42.6% produced an adequate sputum sample, and 32.7% had an abnormal sputum. By individual, infectious bronchitis was the most common (25.7%), followed by eosinophilic bronchitis (13.9%). Comparing the 6-months prior to and after the first clinic visit, there was a lower incidence rate ratio after visit 1 for COPD-related healthcare utilization (0.26 (95%CI 0.22,0.33; p < 0.001)). A COPD post-discharge clinic combining sputum-guided treatment and CCM was feasible and associated with a nearly 75% reduction in the incidence of COPD-related healthcare utilization.

Keywords:

• COPD
• exacerbations
• sputum cell counts
• comprehensive care management
• clinic intervention

Acknowledgements

The authors would like to acknowledge Dr. Alistair Ingram, Ms. Jane Loncke, Ms. Donna Johnson, and Ms. Marnie Buchanan for facilitating the organization of this clinic.

Declaration of interest

TH reports grants and non-financial support from Fisher and Paykel healthcare, and personal fees from Sanofi, outside the submitted work, and is supported by the McMaster Department of Medicine Early Career Award. JW reports grants and non-financial support from Fisher and Paykel healthcare, personal fees from GSK, outside the submitted work. NR reports grants from Boehringer-Ingelheim, outside the submitted work. PN reports grants and personal fees from AZ, grants from Novartis, grants and personal fees from Teva, grants from Sanofi, grants and personal fees from Roche, personal fees from Novartis, personal fees from Merck, personal fees from Equillium, grants from Foresee, outside the submitted work, and is supported by the Frederick E Hargreave Teva Innovation Chair in Airway Diseases. The other authors report no conflict of interest.