The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001 ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006 ). There was a significant increase in inpatient mortality in 2020 (19.3% [ n = 23 ] and 8.4% [ n = 22 ] for 2020 and 2019, respectively, p = 0.003 ). Year was found to be the best predictor of mortality outcome ( p = 0.001 ). The lack of use of SABA pre-admission treatment ( p = 0.002 ), active malignancy ( p = 0.003 ), and increased length of hospital stay ( p = 0.046 ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

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Re-admissions to hospital and patient satisfaction among patients with chronic obstructive pulmonary disease after telemedicine video consultation - a retrospective pilot study

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2014.363 ◽

2014 ◽

Vol 9 ◽

Author(s):

Safaa Saleh ◽

Jan Petter Larsen ◽

Johannes Bergsåker-Aspøy ◽

Heidi Grundt

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Patient Satisfaction ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Number Of Patients ◽

Video Consultation ◽

The Impact

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of acute hospital admissions. The main object of our study was to evaluate the effects of telemedicine video-consultation (TVC) on the frequency of hospital re-admissions due to COPD exacerbations. Our secondary aim was to assess the impact of TVC on the length of re-admission stays within 6 and 12 months follow up after TVC. Patient satisfaction was also evaluated. Methods: The study was a retrospective observational study of COPD patients who after hospital discharge or during outpatient treatment for acute COPD exacerbations, were monitored for 2 weeks by TVC at home by a specialist nurse at the hospital during a pilot project period. Retrospectively, we compared the frequencies (chi-square test) and durations of hospital re-admissions (paired t-test) due to COPD exacerbations within 6 and 12 months follow up after TVC to comparable events 6 and 12 months prior to TVC. Results: Among 99 patients followed for 6 months after TVC, 56 were followed for totally 12 months. The number of patients re-admitted and the number of re-admissions due to COPD exacerbations were not reduced within 6 or 12 months post-TVC, as compared to 6 and 12 months pre-TVC. The mean length of re-admission stays within 12 months post-TVC was markedly reduced as compared to pre-TVC. Patients hospitalised the last 6 and 12 months pre-TVC, had significantly shorter re-admission stays, p = 0.033 and p = 0.001, respectively. Patient satisfaction was high. Conclusion: Despite the failure to demonstrate reduced frequency of re-admissions within 6 and 12 months post-TVC, the re-admission length within 12 months post-TVC was markedly reduced as compared to pre-TVC. The patient satisfaction was high. Future prospective, randomised, controlled trials must be performed before TVC can be recommended in COPD management.

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Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) Comorbidities in Lithuanian National Database: A Cluster Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020970 ◽

2022 ◽

Vol 19 (2) ◽

pp. 970

Author(s):

Elena Jurevičienė ◽

Greta Burneikaitė ◽

Laimis Dambrauskas ◽

Vytautas Kasiulevičius ◽

Edita Kazėnaitė ◽

...

Keyword(s):

Lung Cancer ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Kidney Diseases ◽

Screening Tools ◽

National Database ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Significant Difference ◽

The Impact

Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40–79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD—five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.

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Glycemic Control & Morbidity in Diabetics With COPD Exacerbation. A Retrospective Study

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.844 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A414-A414

Author(s):

Ibrahim Naoum ◽

Abedalghani Abedalhalim ◽

Amir Aker ◽

Luai Khalaili ◽

Sameer Kassem

Keyword(s):

Mechanical Ventilation ◽

Glycemic Control ◽

Population Based ◽

Chronic Obstructive ◽

P Value ◽

Diabetic Patients ◽

Copd Exacerbation ◽

Copd Exacerbations ◽

Significant Difference ◽

The Impact

Abstract Background: Diabetes and chronic obstructive pulmonary disease (COPD) are widely prevalent and comorbidity with these diseases is quite common. However, there is limited data on the interrelation between glycemic control and COPD exacerbations in diabetic patients. Objective: To study the association between pre-admission glycemic control and COPD clinical outcomes including mortality, risk of hospital readmission and the need for mechanical ventilation. Methods: A retrospective population-based cohort study. We screened for patients with both diabetes and COPD exacerbation aged 35 years and above. Pre-admission glycemic control was defined by the last HBA1C level prior to hospitalization. Patients with HBA1C>8% were defined as uncontrolled. We evaluated the difference between controlled and uncontrolled groups in the rates of mortality, readmission and the need for mechanical ventilation. We examined demographic and clinical parameters that might reflect COPD severity including: COPD medication use, blood hemoglobin, platelets, LDH and CRP levels. Results: 513 hospitalizations with diabetes and COPD were screened. 222 hospitalization were excluded either due to unestablished diagnosis of COPD or due to lack of HBA1C test in the preceding year. Of the remaining 291, 208 admissions were with controlled diabetes whereas 83 were uncontrolled. Although not statistically significant, the rate of re-hospitalization was higher in the uncontrolled group (OR 1.99, CI 0.99–4.0, p-value 0.051). There was no statistically significant difference in mortality (OR 1.6, CI 0.73–3.5, p-value 0.243). The use of oxygen and the need for noninvasive mechanical ventilation were significantly higher in the uncontrolled group (67.5% vs. 52.4%, p-value 0.019, 33.7% versus 18.8%, p-value 0.006, respectively). There was no significant difference in possible confounders tested between the groups. Conclusion: Uncontrolled diabetes may adversely affect patients with COPD exacerbation. Larger studies are needed to conclusively determine the impact of glycemic control on COPD morbidity and mortality.

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Comparing the impact of different exercise interventions on fatigue in individuals with COPD: A systematic review and meta-analysis

Chronic Respiratory Disease ◽

10.1177/1479973119894855 ◽

2019 ◽

Vol 16 ◽

pp. 147997311989485 ◽

Cited By ~ 1

Author(s):

Lok Sze Katrina Li ◽

Stacey Butler ◽

Roger Goldstein ◽

Dina Brooks

Keyword(s):

Meta Analysis ◽

Interval Training ◽

Cochrane Library ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Exercise Interventions ◽

Significant Difference ◽

Related Quality ◽

Type Of Exercise ◽

The Impact

To systematically review randomized controlled trials that compared the effectiveness of different types of exercise on the symptom of fatigue in individuals with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, EMcare, PsychINFO, and Cochrane library were searched from inception to October 2018. Studies were included if individuals with COPD were randomized into two or more physical exercise interventions that reported fatigue. Of the 395 full-texts reviewed, 17 studies were included. Fifteen studies reported the impact of exercise on health-related quality of life with fatigue as a subdomain. Reduction in fatigue was observed following endurance, resistance, or a combination of both exercises. There was no significant difference between continuous and interval training ( n = 3 studies, pooled standardized mean difference (SMD) = −0.17, 95% CI = −0.47, 0.12, p = 0.25) or between endurance and resistance training ( n = 3 studies, SMD = −0.35, 95% CI = −0.72, 0.01, p = 0.07) on fatigue in people with COPD. Fatigue reduction is not usually a primary outcome of exercise interventions, but it is frequently a secondary domain. The type of exercise did not influence the impact of exercise on fatigue, which was reduced in endurance, resistance, or a combination of both exercises, enabling clinicians to personalize training to match targeted outcomes.

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Management of chronic obstructive pulmonary disease: A review focusing on exacerbations

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz306 ◽

2020 ◽

Vol 77 (4) ◽

pp. 259-268

Author(s):

Suzanne G Bollmeier ◽

Aaron P Hartmann

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Patient Education ◽

Disease Management ◽

Pulmonary Disease ◽

The United States ◽

Chronic Obstructive ◽

Severe Exacerbation ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

The Impact

Abstract Purpose Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. Exacerbations— acute worsening of COPD symptoms—can be mild to severe in nature. Increased healthcare resource use is common among patients with frequent exacerbations, and exacerbations are a major cause of the high 30-day hospital readmission rates associated with COPD. Summary This review provides a concise overview of the literature regarding the impact of COPD exacerbations on both the patient and the healthcare system, the recommendations for pharmacologic management of COPD, and the strategies employed to improve patient care and reduce hospitalizations and readmissions. COPD exacerbations significantly impact patients’ health-related quality of life and disease progression; healthcare costs associated with severe exacerbation-related hospitalization range from $7,000 to $39,200. Timely and appropriate maintenance pharmacotherapy, particularly dual bronchodilators for maximizing bronchodilation, can significantly reduce exacerbations in patients with COPD. Additionally, multidisciplinary disease-management programs include pulmonary rehabilitation, follow-up appointments, aftercare, inhaler training, and patient education that can reduce hospitalizations and readmissions for patients with COPD. Conclusion Maximizing bronchodilation by the appropriate use of maintenance therapy, together with multidisciplinary disease-management and patient education programs, offers opportunities to reduce exacerbations, hospitalizations, and readmissions for patients with COPD.

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Exacerbations of COPD

European Respiratory Review ◽

10.1183/16000617.0103-2017 ◽

2018 ◽

Vol 27 (147) ◽

pp. 170103 ◽

Cited By ~ 54

Author(s):

Christian Viniol ◽

Claus F. Vogelmeier

Keyword(s):

Viral Infections ◽

Inhaled Corticosteroids ◽

Current Knowledge ◽

Pneumococcal Vaccination ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Copd Exacerbations ◽

Recommended Treatment ◽

Number Of Patients ◽

The Impact

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with β-agonists and anticholinergics as well as systemic corticosteroids. Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure.

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Hospital-Based Clinical Pharmacy Services to Improve Ambulatory Management of Chronic Obstructive Pulmonary Disease

Journal of Pharmacy Technology ◽

10.1177/8755122516675635 ◽

2016 ◽

Vol 33 (1) ◽

pp. 8-14 ◽

Cited By ~ 4

Author(s):

Amber Lanae Smith ◽

Valerie Palmer ◽

Nada Farhat ◽

James S. Kalus ◽

Krishna Thavarajah ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Ambulatory Care ◽

Pulmonary Disease ◽

Clinical Pharmacy ◽

Chronic Obstructive ◽

Pharmacy Services ◽

Obstructive Pulmonary Disease ◽

Clinical Pharmacy Services ◽

Significant Difference ◽

The Impact

Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group ( P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days ( P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.

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Inhalation glucocorticosteroids in the treatment of chronic obstructive pulmonary disease

Russian Pulmonology ◽

10.18093/0869-0189-2020-30-3-330-343 ◽

2020 ◽

Vol 30 (3) ◽

pp. 330-343

Author(s):

S. N. Avdeev ◽

Z. R. Aisanov ◽

V. V. Arkhipov ◽

A. S. Belevskiy ◽

I. V. Leshchenko ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Chronic Obstructive Lung Disease ◽

Clinical Excellence ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Patient Reported ◽

The Impact

The main objectives of chronic obstructive pulmonary disease (COPD) therapy are to reduce the severity of symptoms and the risk of exacerbations. The article discusses the role of local and systemic inflammation in the pathogenesis of COPD as well as various mechanisms of pharmacological influence on it. Approaches to prescribing basic therapy for patients with COPD, recommended by various national and global guidelines (clinical recommendations of the Russian respiratory society, criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines of the National Institute for Health and Clinical Excellence (NICE)), as well as recommendations on the therapy frequency review are considered. Currently, so-called triple combinations – fixed combinations of double bronchodilators with inhaled glucocorticosteroids – are being developed and registered in the world, and their place and significance in the treatment of COPD raise many discussions. The paper discusses the role of fixed triple combinations in reducing the incidence of COPD exacerbations, the impact on functional and patient-reported outcomes, and provides recommendations for the use of triple combinations in patients with COPD, taking into account the benefit/risk ratio.

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Day of surgery: the impact on patient length of stay in a tertiary vascular unit

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0075 ◽

2020 ◽

Vol 102 (2) ◽

pp. 98-103 ◽

Cited By ~ 1

Author(s):

NC Holford ◽

C Ní Ghuidhir ◽

L Hands

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Support Services ◽

Length Of Hospital Stay ◽

Abdominal Aortic Aneurysm Repair ◽

Significant Difference ◽

Postoperative Length ◽

The Difference ◽

Aneurysm Repair ◽

The Impact

Background Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. Methods We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. Results We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). Conclusion Day of surgery appears to impact on patients’ length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.

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Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2003000200006 ◽

2003 ◽

Vol 61 (2A) ◽

pp. 188-193 ◽

Cited By ~ 25

Author(s):

Norberto L. Cabral ◽

Carla Moro ◽

Giana R. Silva ◽

Rosana Herminia Scola ◽

Lineu César Werneck

Keyword(s):

Hospital Stay ◽

Stroke Unit ◽

Survival Curve ◽

Clinical Status ◽

Randomized Study ◽

Length Of Hospital Stay ◽

General Ward ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU) on acute phase treatment when compared to a conventional general ward treatment (GW). METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW). We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41), whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24), 17.4% and 28.7% on the 3rd month (p= 0.39), and 25.7% and 30.7% on the 6th month (p= 0.41). Thirty-day survival curve achieved 1.8 log rank (p= 0.17), with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat) was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.

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