Clinical Outcome of a Cross-Sectorial Lung Team Treating Patients with COPD at High Risk of Exacerbation: A Randomized Controlled Trial

Figures & data

Figure 1. Flowchart of patient inclusion.

Table 1. Baseline characteristics.

	Intervention group (N = 56)			Control group (N = 57)
	mean (SD) range	n	%	mean (SD) range		n
Sex
Female		30	53.6			28	49.1	0.636
Male		26	46.4			29	50.9	0.636
Age (year)	71.6 (9.0) 51 − 90			71.5 (9.0) 47 − 86
<50		0	0.0			2	3.5	0.157
50-59		5	8.9			4	7.0	0.708
60-69		16	28.6			14	24.6	0.629
70-79		23	41.1			26	45.6	0.626
80-89		11	19.6			11	19.3	0.963
>90		1	1.8			0	0.0	0.311
FEV1 (% of predicted)	37.1 (13.5) 14 − 71*			33.6 (12.9) 14 − 82
<30		20	36.4			24	42.1	0.534
30-49		25	45.5			27	47.4	0.839
50 − 79		10	18.2			5	8.8	0.144
>80		0	0.0			1	1.8	0.324
BMI (kg/m^2)	25.5 (6.2) 15.2 − 39.5			24.9 (6.7) 15.4 − 46.5
<18.5		9	16.1			6	10.5	0.385
18.5-24.9|		18	32.1			28	49.1	0.066
25-29.9		17	30.4			14	24.6	0.490
>30		12	21.4			9	15.8	0.441
MRC (1-5)	3.7 (0.9) 2 − 5**			3.7 (0.9) 2 − 5
1		0	0.0			0	0.0
2		4	7.3			4	7.0	0.958
3		19	34.5			22	38.6	0.656
4		19	34.5			17	29.8	0.593
5		13	23.6			14	24.6	0.909
CAT score (0-40) 23.7 (6.3) 9 − 37***				22.2 (7.2) 5 − 35****
Smoking status
Smoker		25	44.6			17	29.8	0.103
Ex-smoker		31	55.4			40	70.2	0.103
Marital status
Spouse/cohabiting partner		21	42.9			31	54.4	0.220
Relationship		1	1.8			1	1.8	0.990
Single		31	55.4			25	43.9	0.222
Residence
Own residence		45	80.4			57	100.0	<0.001
Sheltered housing		8	14.3			0	0.0	0.003
Nursing home		3	5.4			0	0.0	0.077
AmbuFlex*****
Affiliation		20	35.7

* 1 missing value.

** 1 missing value.

*** 5 missing values.

**** 3 missing values.

***** Most patients declined using AmbuFlex for various reasons; FEV₁, Forced expiratory volume in one second; BMI, Body mass index; MRC, Medical Research Council breathlessness scale; CAT, COPD Assessment Test.

Table 2. Baseline characteristics regarding comorbidities, oxygen use and NIV therapy.

	Intervention group (N = 56)			Control group (N = 57)
	n	%		n	%	P-value
Charlson comorbidity index
0	10	17.9		14	24.6	0.384
1 − 2	30	53.6		31	54.4	0.931
≥ 3	16	28.6		12	21.1	0.355
Comorbidities
Ischemic heart disease	12	21.4		13	22.8	0.860
Heart failure	26	46.4		26	45.6	0.931
Arrhythmia	8	14.3		10	17.5	0.636
Peripheral vascular disease	22	39.3		25	43.9	0.622
Hypertension	30	53.6		26	45.6	0.398
Osteoporosis	42	75.0		46	80.7	0.465
Anxiety	14	25.0		12	21.1	0.618
Depression	19	33.9		22	38.6	0.606
Diabetes	12	21.8		3	5.3	0.010
Gastroesophageal reflux	23	41.1		23	40.4	0.938
Bronchiectasis	4	7.1		5	8.8	0.749
Schizophrenia	4	7.1		0	0.0	0.040
Rheumatic disease	5	8.9		5	8.8	0.977
Kidney disease	1	1.8		4	7.0	0.176
Cerebrovascular disease	5	8.9		4	7.0	0.708
Oxygen and NIV
LTOT	11	19.6		14	24.6	0.529
Home NIV therapy	4	7.1		4	7.0	0.979

LTOT, Long-term oxygen therapy; NIV, Noninvasive ventilation.

Table 3. Overview of hospitalizations in relation to main cause.

	Intervention group (N = 56)		Control group (N = 57)		Differences: Intervention group – control group
	n	mean (95% CI)	n	mean (95% CI)	n	mean (95% CI)	p-value
Total hospitalizations related to diagnosis
AECOPD	33	0.0.59 (0.35; 0.83)	106	1.86 (1.12; 2.60)	−73	−1.27 (-2.06; −0.48)	0.002
Comorbidities and COPD	15	0.27 (0.12; 0.41)	21	0.37 (0.16; 0.58)	−6	−0.10 (-0.36; 0.16)	0.451
Other causes	47	0.84 (0.46; 1.22)	55	0.97 (0.57; 1.36)	−8	−0.13 (-0.74; 0.49)	0.690
Hospitalizations related to AECOPD	n	% (95% CI)	n	% (95% CI)	n	% (95% CI) p-value
No hospitalizations	37	66.1 (53.7; 78.5)	30	52.6 (39.7; 65.6)	7	13.4 (-4.5; 31.4)	0.146
1-2 hospitalizations	14	25.0 (13.7; 36.3)	12	21.1 (10.5; 31.6)	2	3.9 (-11.6; 19.5)	0.618
≥3 hospitalizations	5	8.9 (1.5; 16.4)	15	26.3 (14.9; 37.7)	−10	−17.4 (-31.0; −3.7)	0.016
Hospitalizations related to comorbidities and COPD
No hospitalizations	44	78.6 (67.8; 89.3)	42	73.7 (62.3; 85.1)	2	4.9 (10.8; 20.6)	0.542
1-2 hospitalizations	12	21.4 (10.7; 32.2)	14	24.6 (13.4; 35.7)	−2	−3.1 (-18.6; 12.4)	0.692
≥3 hospitalizations	0	0.0 (0.0; 0.0)	1	1.8 (-1.7; 5.2)	−1	−1.8 (-5.2; 1.7)	0.319
Hospitalizations related to other causes
No hospitalizations	32	57.1 (44.2; 70.1)	31	54.4 (41.5; 67.3)	1	2 .8 (-15.6; 21.1)	0.768
1-2 hospitalizations	18	32.1 (19.9; 44.4)	18	31.6 (19.5; 43.6)	0	0.6 (-16.6; 17.7)	0.949
≥3 hospitalizations	6	10.7 (2.6; 18.8)	8	14.0 (5.0; 23.1)	−2	−3.3 (-15.4; 8.8)	0.592

Table 4. Overview of contacts to CLT before hospitalization – divided by main cause.

	Hospitalizations due to AECOPD	Hospitalizations due to	Hospitalizations due to other causes
	(N = 33)	Comorbidities and COPD	(N = 47)
		(N = 15)
	n %	n %	n %
Contact to CLT	20 (60.6%)	6 (40.0%)	6 (12.8%)
No contact to CLT	13 (39.4%)	9 (60.0%)	41 (87.2%)

Table 5. Length of hospital stay divided by main cause.*

Length of stay	Intervention group		Control group		Differences Intervention group – control group
	mean (SD) (95% CI)		mean (SD) (95% CI)		mean (95% CI)		p-value
AECOPD	3.27 (2.92) (2.39; 4.15)		4.47 (3.70) (3.70; 5.24)		−1.20 (-2.37; −0.03)		0.045
Comorbidities and COPD	4.93 (4.18) (2.63; 7.23)		4.86 (3.90) (2.98; 6.74)		0.07 (-2.37; 2.52)		0.951
Other causes	2.66 (5.62) (1.06; 4.26)		3.96 (6.33) (2.39; 5.54)		− 1.30 (-3.34; 0.73)		0.210
	n % (95% CI)		n %	(95% CI)	n % (95% CI)		p-value
AECOPD	(N = 33)		(N= 106)
0-2 days	19	57.6 (53.7; 75.7)	35	33.0 (39.4; 45.9)	−14	24.5 (5.5; 43.6)	0.042
3-5 days	7	21.2 (4.7; 37.7)	38	35.8 (25.8; 45.9)	− 31	−14.6 (−31.3; 2.0)	0.133
≥6 days	7	21.2 (6.0; 36.4)	33	31.1 (22.2; 40.0)	− 26	−9.9 (−26.4; 6.6)	0.286
Comorbidities and COPD	(N = 15)		(N = 21)
0-2 days	5	33.3 (9.3; 57.3)	6	28.6 (10.2; 46.9)	−1	4.8 (−25.9; 35.5)	0.744
3-5 days	6	40.0 (15.1; 64.9)	8	38.1 (16.7; 59.5)	2	1.9 (−30.4; 34.2)	0.905
≥6 days	4	26.7 (-0.7; 54.1)	7	33.3 (11.3; 55.4)	−3	−6.7 (−36.8; 23.5)	0.694
Other causes	(N = 47)		(N = 55)
0-2 days	38	80.9 (69.1; 92.6)	36	65.5 (52.2; 78.7)	2	15.4 (−1.5; 32.3)	0.118
3-5 days	3	6.4 (0.0; 12.8)	4	7.3 (1.0; 13.5)	−1	−0.9 ( −10.7; 8.9)	0.853
≥ 6 days	6	12.8 (2.6; 23.0)	15	27.3 (15.3; 39.2)	−9	−14.5 ( −29.7; 0.6)	0.077

* Length of stay counts as zero days if a patient is admitted and discharged on the same day.

Table 6. Overview of in-hospital treatment regimen for AECOPD.

	Intervention group N = 33n n (%)	Control group N = 106 n (%)	p-value
Treatment received at hospitalizations due to AECOPD	Total	Total
No treatment (conversation only)	0 (0.00)	5 (4.72)	0.2038
Oral medication and/or inhaled therapy	13 (39.39)	45 (42.45)	0.7557
Intravenous therapy with antibiotics	7 (21.21)	12 (11.32)	0.1486
Oxygen therapy +/- additional medication	8 (24.24)	27 (25.47)	0.8870
NIV therapy +/- additional medication	5 (15.15)	17 (16.04)	0.9031

AECOPD, acute exacerbation of chronic obstructive pulmonary disease; CLT, Cross-sectorial lung team; NIV, noninvasive ventilation.