Systemic Corticosteroid and Antibiotic Use in Hospitalized Patients With Chronic Obstructive Pulmonary Disease Exacerbation

2018 ◽  
Vol 53 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Sarah E. Petite ◽  
Julie A. Murphy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Antibiotic Therapy ◽  
Pulmonary Disease ◽  
Systemic Corticosteroid ◽  
Standard Dose ◽  
Antibiotic Use ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease

Background: Effective inpatient chronic obstructive pulmonary disease (COPD) exacerbation management is critical to appropriately manage health care resources. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines provide recommendations on appropriate systemic corticosteroid and antibiotic use, in select patients, for COPD exacerbation. Objective: To determine the impact of GOLD guideline–recommended systemic corticosteroid and antibiotic therapy in the hospital setting on clinical outcomes in patients with COPD exacerbation. Methods: This was a noninterventional, retrospective, single-center study. Adults admitted to a non–intensive care unit internal medicine service with documented COPD exacerbation were included. Two analyses were conducted evaluating systemic corticosteroid and antibiotic therapy. Results: A total of 220 patients were included in the systemic corticosteroid cohort. No difference in 30-day readmission rates was demonstrated for the standard (⩽200 mg prednisone equivalents [PEs] for exacerbation course) and high-dose groups (>200 mg PEs; 20.5% vs 13.1%, respectively; P = 0.15). Hospital length of stay (LOS) was significantly shorter for patients prescribed standard-dose therapy (3 days [2-4.5] vs 4 days [2-6]; P < 0.001). A total of 174 patients were included in the antibiotic cohort. For the appropriate and inappropriate antibiotic use groups, no significant differences were observed between 30-day readmission rates (15% vs 18.4%, respectively; P = 0.57) and hospital LOS (4 days [2-5] in both groups; P = 0.97). Conclusion and Relevance: Hospital LOS was shorter for patients prescribed standard-dose systemic corticosteroids; however, no differences in other clinical outcomes were found in either cohort. Use of guideline-recommended systemic corticosteroid and antibiotic therapy is recommended for hospitalized patients with COPD exacerbation.

Impact of the implementation of a pharmacist-driven chronic obstructive pulmonary disease exacerbation orderset in an inpatient setting

2020 ◽  
Vol 77 (14) ◽  
pp. 1128-1134
Author(s):  
Sarah E Petite ◽  
Julie A Murphy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Systemic Corticosteroid ◽  
Antibiotic Use ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Blood Pressure Elevation ◽  
The Impact

Abstract Purpose The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines provide recommendations for the management of chronic obstructive pulmonary disease (COPD) exacerbation. Studies have demonstrated shortened hospital length of stay (LOS) with use of guideline-adherent systemic corticosteroid therapy. There are no published studies evaluating the impact of an inpatient orderset on patient-oriented outcomes. Methods This institutional review board–approved, retrospective, quasi-experimental, single-center cohort study included adult patients admitted to an internal medicine service for a documented COPD exacerbation from January 2014 through December 2015 (the pre-orderset group) or January 2017 through December 2018 (the post-orderset group). A pharmacy and therapeutics committee–approved orderset recommending guideline-adherent treatment with systemic corticosteroids, scheduled short-acting bronchodilators, and antibiotics was used in the post-orderset group. The primary outcome was hospital LOS. Secondary outcomes included 30-day all-cause and COPD-related readmission rates, systemic corticosteroid–related adverse events, and antibiotic use. Results A total of 358 unique patient encounters were identified for the pre-orderset group (n = 220) and post-orderset group (n = 138). The mean (SD) hospital LOS was significantly shorter in the post-orderset group (3.4 [2.4] days vs 4.3 [3.0] days; P = 0.004). There were no significant between-group differences in rates of 30-day all-cause and COPD-related readmissions. The overall rate of antibiotic use was lower in the post-orderset group vs the pre-orderset group (71% vs 90.2%; P &lt; 0.001). The rate of occurrence of new blood glucose elevation was significantly lower in the post-orderset group (49.3% vs 79.1%; P &lt; 0.001), with no significant between-group difference in occurrence of new blood pressure elevation. Conclusion A significant reduction in hospital LOS was found with the implementation of a pharmacist-driven COPD exacerbation orderset.

scholarly journals ANTIBIOTIC THERAPY IN ACUTE EXACERBATION OF COPD:AN OPTIMAL WAY TO SUCCESS

2021 ◽  
Vol 29 (2) ◽  
pp. 35-40
Author(s):  
L. V. Yudina
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Antibiotic Therapy ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Family Practitioner ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Exacerbation Of Copd

Currently, chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Acute exacerbation of the disease is associated with fast clinical deterioration, increased respiratory tract inflammation and lung function disorders. Acute exacerbation of COPD dramatically worsens patient�s prognosis and serves as an important indicator of therapy effectiveness. Family practitioner should recognize this condition and correctly chose proper antibiotic. Diagnosis of COPD exacerbation is based on clinical manifestations of the disease. Depending on presence of primary or secondary symptoms COPD exacerbations are divided into several types. Antibiotic therapy appears to be more beneficial in patients with type 2 or 3 exacerbation. Sputum purulence is considered an obligatory symptom. As a rule, in complicated course of acute exacerbation of COPD protected aminopenicillins or 3rd generation cephalosporins are the firsline antibiotics. In most cases of COPD exacerbation antibiotics are prescribed orally. If first-line antibacterial therapy fails, the respiratory fluoroquinolones (levofloxacin of moxifloxacin) are prescribed. The author, using her own experience with levofloxacin, gives an example of proper choice of antibiotic if such a situation. Successful experience of management of acute exacerbation of COPD may be useful for general practitioners, physicians, pulmonologists. Key words: chronic obstructive pulmonary disease, exacerbation, antibiotic therapy, levofloxacin.

scholarly journals Evaluation of Bronchodilator Use During Chronic Obstructive Pulmonary Disease Exacerbation Inpatient Admissions

2018 ◽  
Vol 54 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Sarah E. Petite ◽  
Julie A. Murphy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hospital Admission ◽  
Pulmonary Disease ◽  
Readmission Rate ◽  
Hospital Setting ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
The Impact

Background: It is unknown whether the timing of initiation of a long-acting bronchodilator (LABD) during a chronic obstructive pulmonary disease (COPD) exacerbation or the method of short-acting bronchodilator (SABD) delivery may aid in improving patient outcomes. Objective: The goal of this study was to determine the impact of bronchodilator management in the hospital setting on clinical outcomes in patients with COPD exacerbation. Methods: This retrospective, single-center study evaluated patients admitted to the non-intensive care unit setting with a COPD exacerbation as defined by the International Classification of Diseases, Ninth Revision codes. The primary outcome was difference in 30-day readmission rates for early LABD therapy (<24 hours from hospital admission) versus late/no LABD therapy (>24 hours from hospital admission or not during hospitalization). Secondary objectives included length of stay (LOS) for this group, and 30-day readmission rates and LOS for the SABD via inhaler versus nebulizer groups. Results: Two hundred twenty patients were included. There was no difference in 30-day readmission rate (15.2% vs 18.2%, P = .6) and LOS (median 4 [interquartile range, IQR 3-6]) days for both groups, P = .34) between early versus late/no LABD therapy initiation, respectively. No difference was observed in 30-day readmission rate (16.7% vs 16.6%) and LOS (median 2.5 [IQR 1.1-3.9] days vs median 4 [IQR 2-6] days) between inhaler and nebulizer SABD therapy groups. Conclusions: No difference was observed in 30-day readmission rates or LOS when utilizing early LABD compared with late/no LABD therapy or comparing inhaler and nebulizer SABD delivery methods during COPD exacerbation.

scholarly journals European hospital adherence to GOLD recommendations for chronic obstructive pulmonary disease (COPD) exacerbation admissions: Table 1

Thorax ◽  
2013 ◽  
Vol 68 (12) ◽  
pp. 1169-1171 ◽  
Author(s):  
C Michael Roberts ◽  
Jose Luis Lopez-Campos ◽  
Francisco Pozo-Rodriguez ◽  
Sylvia Hartl ◽  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease

scholarly journals Real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China: Evidence from the ACURE study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yiming Ma ◽  
Ke Huang ◽  
Chen Liang ◽  
Xihua Mao ◽  
Yaowen Zhang ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Real World ◽  
Antibiotic Use ◽  
Tertiary Hospital ◽  
Chronic Obstructive ◽  
Oral Antibiotics ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations ◽  
Hospital Group

Background: The evidence for real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is insufficient. This study aimed to investigate real-world antibiotic use in the management of AECOPD in China.Methods: All hospitalized AECOPD patients from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study conducted at 163 sites between January 2018 and December 2019 were screened according to the eligible criteria. The eligible study population was divided into secondary and tertiary hospital groups. Patients’ baseline characteristics, antibiotic use, and bacterial pathogen characteristics were retrieved and analyzed using SPSS 23.0.Results: A total of 1663 patients were included in the study, including 194 patients from secondary hospitals and 1469 patients from tertiary hospitals. Among the 1663 AECOPD patients enrolled, 1434 (86.2%) received antibiotic treatment, comprising approximately 85.6% and 86.3% of patients in the secondary and tertiary hospital groups, respectively. The median antibiotic therapy duration was 9.0 (interquartile range [IQR]: 7.0 - 11.0)°days. Regarding the routes of antibiotic use, 1400 (97.6%) patients received intravenous antibiotics, 18 (1.3%) patients received oral antibiotics, 15 (1.0%) patients received both intravenous and oral antibiotics, and one (0.1%) patient received both oral and nebulized antibiotic treatment. In addition, cephalosporin, penicillin, and quinolone were the most commonly prescribed antibiotics (43.6%, 37.0%, and 34.2%, respectively). In total, 990 (56.5%) patients underwent pathogen examinations; the proportion of patients receiving pathogen examinations in the second hospital group was significantly lower than that in the tertiary hospital group (46.4% vs 61.3%, p &lt; 0.001).Conclusion: This study demonstrates that an antibiotic overuse may exist in the treatment of AECOPD in China. Measures should be taken to prevent the overuse of antibiotics and potential antimicrobial resistance (AMR) in Chinese AECOPD patients.

Point-of-Care COPD Diagnostics: Biomarkers, Sampling, Paper-based Analytical Devices, and Perspectives

The Analyst ◽  
2022 ◽  
Author(s):  
Guozhen He ◽  
Tao Dong ◽  
Zhaochu Yang ◽  
Are Branstad ◽  
Lan Huang ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Early Diagnosis ◽  
Pulmonary Disease ◽  
Economic Burden ◽  
Point Of Care ◽  
Diagnosis And Treatment ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
The Third

Chronic Obstructive pulmonary disease (COPD) has become the third leading causes of global death. Insufficiency in early-diagnosis and treatment of COPD, especially COPD exacerbation, leads to tremendous economic burden and...

Sign in / Sign up

Export Citation Format

Share Document