Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Are There Significant Differences Between Hospitalized and Emergency Department Patients?

Abstract

Rationale

Current guidelines define a severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) as an increase in symptoms requiring hospital admission or emergency department (ED) visit. Little is known about whether or not subjects requiring hospitalization and those needing only ED care have similar patient profiles and if their clinical outcomes appear comparable.

Objective

The main goals of this study were to compare the demographic and clinical characteristics of patients treated for an AECOPD with an inpatient admission versus an ED visit and to review if hospital resource utilization was different between the 2 groups after discharge.

Methods

Subjects treated in 2022 at Montfort Hospital for an AECOPD were reviewed. Patient demographic information was collected in addition to spirometry results and blood eosinophil counts on file. Supplemental oxygen use and medication lists were also recorded. Patients with an initial hospital admission were compared to those requiring only ED care with univariate and multivariate analyses. We also assessed if subjects were again treated for an AECOPD up to 6 months post initial discharge, and if so, the type of hospital visits (hospitalization or ED).

Measurements and Main Results

A total of 135 individuals necessitated hospitalization and 79 received ED care for the treatment of an AECOPD. On univariate analysis, patients requiring an inpatient stay appeared older and were more likely to have spirometry results on file. A greater proportion of hospitalized individuals were on supplemental oxygen and prescribed at least one long-acting inhaled medication. These studied variables remained significant after multivariate logistic regression analysis. Subjects with an initial inpatient admission were also more likely to require hospitalization upon repeat presentation for a severe AECOPD.

Conclusion

Given the important differences observed in both patient characteristics and hospital resource utilization, this study supports considering an AECOPD requiring inpatient admission versus an ED visit as distinct categories of events.

Keywords:

• chronic obstructive pulmonary disease
• guidelines
• severe acute exacerbation
• hospitalization
• emergency department

Abbreviations

AECOPD, acute exacerbation of chronic obstructive pulmonary disease; BEC, blood eosinophil counts; CTS, Canadian Thoracic Society; ED, emergency department; EMR, electronic medical records; FEV1, forced expiratory volume in the first second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; OCS, oral corticosteroids; PCP, primary care provider; REB, research ethics board.

Disclosure

No conflicts exist for the author.

Additional information

Funding

Montfort Hospital.