Respiratory Specialist Visits Before Admissions with COPD Exacerbation Are Linked to Improved Management and Outcomes

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2024 Nov 11

PMID 39525519

Authors

Ariel Melloul

Ophir Freund

Boaz Tiran

Tal Moshe Perluk

Netanel Golan

Eyal Kleinhendler

Evgeni Gershman

Avraham Unterman

Avishay Elis

Amir Bar-Shai

Affiliations

Soon will be listed here.

Abstract

Purpose: Exacerbations of COPD (ECOPD) significantly impact disease progression and mortality. Visiting a respiratory specialist (RS) in proximity to the exacerbation may lead to prompt treatment and improved outcomes. We aimed to evaluate the association between an RS visit 30-days before admission and exacerbation outcomes.

Patients And Methods: The prospective study included subjects that were hospitalized with ECOPD between 2017 and 2019 in 13 medical centers. Pre-admission, in-hospital, and 30-day outcomes were assessed and compared between patients with and without a 30-day RS visit, using propensity score matching. A sub-group analysis was performed based on the reason for the RS visit (emergent vs regular follow-up).

Results: Three hundred and forty-four subjects were included, and 105 (31%) had pre-admission RS visit (RS group). Before matching, indicators of severe COPD were prevalent in the RS group, while after matching there were no differences. RS visits were associated with pre-hospital initiation of short acting bronchodilators (50% vs 36%), antibiotics (30% vs 17%), and systemic steroids (38% vs 22%). The RS group had longer duration between first symptoms to hospital arrival (median 5 vs 3 days, p < 0.01) and shorter hospital length-of-stay (median 4 vs 5 days, p = 0.04). In-hospital and 30-days outcomes were similar between the groups. However, a non-emergent pre-hospital RS visit was associated with improved in-hospital and 30-day outcomes.

Conclusion: Routine RS visits could lead to correct and early treatment for ECOPD with a potential for improved outcomes. These findings highlight the need for available specialists and higher awareness.

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