Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality

• Published in: PloS one Vol. 13; no. 12; p. e0208847
• Main Authors: Casas-Mendez, Fernando, Abadías, Maria Jose, Yuguero, Oriol, Bardés, Ignasi, Barbé, Ferran, de Batlle, Jordi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.12.2018; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Analysis; Antibiotics; Biology and Life Sciences; Care and treatment; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Combination drug therapy; Drug therapy; Dyspnea; Electronic health records; Electronic medical records; Electronic records; Emergency management; Emergency medical services; Emergency preparedness; Emergency Service, Hospital; Female; Heterogeneity; Hospital admission and discharge; Hospital emergency services; Hospitalization; Hospitals; Humans; Internal medicine; Longitudinal Studies; Lung diseases; Male; Medical prognosis; Medical records; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Models, Biological; Mortality; Obstructive lung disease; Patients; Pharmacology; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - mortality; Regression models; Respiratory system agents; Respiratory tract diseases; Retrospective Studies; Short term; Teachers; Time Factors; Treatment outcome; Working groups; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0208847

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common reason for presentation to emergency departments (ED), but the management of these episodes is often heterogeneous regardless of their potential impact on short-term adverse outcomes. This was a longitudinal, retrospective study of all patients >40 years old admitted to the ED of two Spanish teaching hospitals for an AECOPD between January 1st and May 31st, 2016. All data were collected from electronic medical records. The primary outcomes were patient treatment at discharge and 90-day mortality. Logistic regression was used to model the determinants of 90-day mortality. Of the 465 included patients, 56% were prescribed a 3-drug combination at hospital discharge, 22% a 2-drug combination, 19% a single drug, and 4% other or no treatment. Approximately 8% of patients died within 90 days after an AECOPD. Multivariate logistic models revealed that having more than 2 severe exacerbations within the last 12 months (OR (95% CI): 15.12 (4.22-54.22)) and being prescribed a single drug at discharge (OR (95% CI): 7.23 (2.44-21.38)) were the main determinants of 90-day mortality after an AECOPD. This study reflects the real-life heterogeneity in the pharmacological treatments prescribed after an ED admission for an AECOPD and suggests the potential impact of suboptimal inhaled treatment strategies on 90-day mortality rates.