Optimal glucocorticoid dose and the effects on mortality, length of stay, and readmission rates in patients diagnosed with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

The burden of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is staggering on a national and global level. Yet, surprisingly, there is a profound lack of treatment standardization with glucocorticoids in the treatment of AECOPD. In this review, we bring attention to specific literature that use a cut-off of 60 mg prednisone equivalent per day when distinguishing between high-dose and low-dose glucocorticoid treatment. We hope this review encourages future research to begin incrementally lowering the cut-off dose of 60 mg to discover if mortality, length of hospital stays, and readmission rates change between high-dose and low-dose glucocorticoid treatment. The final hope would be to establish an optimal glucocorticoid dose to treat AECOPD and eliminate treatment ambiguity.

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Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Influence of Social Factors in Determining Length of Hospital Stay and Readmission Rates

Canadian Respiratory Journal ◽

10.1155/2008/569496 ◽

2008 ◽

Vol 15 (7) ◽

pp. 361-364 ◽

Cited By ~ 47

Author(s):

Alyson WM Wong ◽

Wen Q Gan ◽

Jane Burns ◽

Don D Sin ◽

Stephan F van Eeden

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Social Work ◽

Marital Status ◽

Pulmonary Disease ◽

Acute Exacerbation ◽

Social Factors ◽

Chronic Obstructive ◽

Readmission Rates ◽

Obstructive Pulmonary Disease ◽

Hospital Resources

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading reason for hospitalization in Canada and a significant financial burden on hospital resources. Identifying factors that influence the time a patient spends in the hospital and readmission rates will allow for better use of scarce hospital resources.OBJECTIVES: To determine the factors that influence length of stay (LOS) in the hospital and readmission for patients with AECOPD in an inner-city hospital.METHODS: Using the Providence Health Records, a retrospective review of patients admitted to St Paul’s Hospital (Vancouver, British Columbia) during the winter of 2006 to 2007 (six months) with a diagnosis of AECOPD, was conducted. Exacerbations were classified according to Anthonisen criteria to determine the severity of exacerbation on admission. Severity of COPD was scored using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. For comparative analysis, severity of disease (GOLD criteria), age, sex and smoking history were matched.RESULTS: Of 109 admissions reviewed, 66 were single admissions (61%) and 43 were readmissions (39%). The number of readmissions ranged from two to nine (mean of 3.3 readmissions). More than 85% of admissions had the severity of COPD equal to or greater than GOLD stage 3. The significant indicators for readmission were GOLD status (P<0.001), number of related comorbidities (OR 1.47, 95% CI 1.10 to 1.97; P<0.009) and marital status (single) (OR 4.18, 95% CI 1.03 to 17.02; P<0.046). The requirement for social work involvement during hospital admission was associated with a prolonged LOS (P<0.05).CONCLUSIONS: The results of the present study show that disease severity (GOLD status) and number of comorbidities are associated with readmission rates of patients with AECOPD. Interestingly, social factors such as marital status and the need for social work intervention are also linked to readmission rates and LOS, respectively, in patients with AECOPD.

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Frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.11.4059 ◽

2020 ◽

Vol 27 (11) ◽

pp. 2438-2444

Author(s):

Muhammad Absar Alam ◽

Muhammad Sarfraz ◽

Arsalan Hafeez ◽

Zafar Ali Zafar ◽

Touseef Anwar ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Acute Exacerbation ◽

Low Dose ◽

Operational Definition ◽

University Hospital ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Duration Of Disease

Objectives: To assess the frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis. Study Design: Cross Sectional study. Setting: Department of Medicine, Independent University Hospital, Faisalabad. Period: 01-07-2017 to 30-06-2018. Material & Methods: 100 patients having diagnosis of COPD according to the operational definition were selected from medical opd of hospital after consent of patients. All patients were given tablet azithromycin 250mg thrice weekly for 12 months, then these patients were followed up for episodes of exacerbations in one year. All patients were properly instructed to report in any change in their symptoms. Any episode of acute exacerbation was noted. There was no conflict of interest. Results: Frequency of acute exacerbation of chronic obstructive pulmonary disease was seen in 70 out of 100(70%) patients taking low dose azithromycin prophylaxis. In female patients frequency of acute exacerbation was high as compared to male patients. i.e. 62.9% vs. 37.1%. Frequency of acute exacerbation was higher in patients whose duration of disease was longer. i.e. 7-10 years followed by patients whose duration of disease was 4-6 years (28.6%) and 1-3 years (25.7%). Presence of acute exacerbation was significantly associated with decline in lung functions. Highest frequency of acute exacerbation was seen in patients who had 3-4 episodes. Conclusion: Results of this study showed a high frequency of acute exacerbation of COPD even with the prophylaxis of low dose azithromycin. However literature reported effectiveness of low dose azithromycin for acute exacerbation in patients of COPD. So further study in the form of randomized trail is needed to prove the efficacy of azithromycin.

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