Frequent hospital readmissions for acute exacerbation of COPD and their associated factors

Cao, Zhenying; Ong, K. C. G.; Eng, Philip; Tan, Wan C.; Ng, Tze Pin

doi:10.1111/j.1440-1843.2006.00819.x

Cited by 111 publications

(118 citation statements)

References 23 publications

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“…This condition has different prevalence in different countries and also in different regions of countries around the world. 2,3 The most significant risk factor for COPD is cigarette smoke. On the other hand, COPD occurs in few tobacco users, and this has not yet been clearly explained.…”

Section: Introductionmentioning

confidence: 99%

Serum Telomerase Levels and COPD Exacerbations

Bozkuş¹,

Güler

Sımsek

2016

Respir Care

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BACKGROUND: To our knowledge, there is no study on the level of telomerase in subjects with COPD during an exacerbation period. The objective of this work was to compare lipid peroxidation, telomerase, zinc (Zn), copper (Cu), and malondialdehyde levels in asymptomatic smokers and subjects with COPD exacerbation. METHODS: The study included 45 subjects with COPD exacerbation and 42 healthy subjects with tobacco use as a control group. Samples were taken from blood and after the serum levels of telomerase malondialdehyde, Cu, and Zn were measured, the values were compared between the 2 groups. Tests for respiratory function were performed, and sedimentation and C-reactive protein levels were measured. RESULTS: The COPD exacerbation group had a significantly (P < .001) lower Cu/Zn ratio compared with the control group; however, the COPD exacerbation group had significantly (P < .001) higher levels of telomerase malondialdehyde, Cu, and Zn compared with the control group. Malondialdehyde, Cu, Zn, and FEV 1 were found negatively correlated in the COPD exacerbation and control groups (P < .001). The COPD exacerbation group had lower FEV 1 and FVC compared with the control group. The COPD exacerbation group had significantly (P < .001) higher levels of C-reactive protein and a higher blood cell sedimentation rate compared with the control group. CONCLUSIONS: The reason why the subjects had a reduced Cu/Zn ratio and increased levels of telomerase, Cu, and Zn is likely to be oxidative stress, which can be defined as an increased exposure to oxidants and/or decreased antioxidant capacities It is obvious from this study that lung oxidant-antioxidant balance is abnormal in subjects with COPD exacerbation and also that the increased level of telomerase is associated with this imbalance.

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Section: Introductionmentioning

confidence: 99%

Serum Telomerase Levels and COPD Exacerbations

Bozkuş¹,

Güler

Sımsek

2016

Respir Care

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“…Acute exacerbations of COPD represent critical events in the course of this disease and are associated with decline in lung function, worse quality of life, and increased mortality (3)(4)(5)(6). The majority of health care costs associated with COPD result from hospitalization (7,8), and approximately one-half of patients hospitalized are readmitted for acute exacerbation within 1 year and up to 22% of patients within 30 days (9)(10)(11). Reducing 30-day readmissions for acute exacerbation of COPD has been recognized recently by the United States Centers for Medicare and Medicaid Services as an important target for both physicians and health care systems (12,13).…”

mentioning

confidence: 99%

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2016

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Rationale: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and health care costs, and hospitals in the United States are now penalized by the Centers for Medicare and Medicaid Services for excessive readmissions. Identifying patients at risk of readmission is important, but modifiable risk factors have not been clearly established, and the potential contributing role of psychological disease has not been examined adequately. We hypothesized that depression and anxiety would increase the risk of both short-and long-term readmissions for acute exacerbation of COPD.Objectives: To characterize the associations between depression and anxiety and COPD readmission risk. Methods:We examined the medical records for all patients with a primary diagnosis of acute exacerbation of COPD by International Classification of Diseases, Ninth Revision codes admitted to the University of Alabama at Birmingham Hospital between November 2010 and October 2012. Those who did not meet the standardized study criteria for acute exacerbation of COPD and those with other respiratory illnesses as the primary diagnosis were excluded. Comorbidities were recorded on the basis of physician documentation of the diagnosis and/or the use of medications in the electronic medical record. Multivariable regression analyses identified factors associated with readmission for acute exacerbation of COPD at 1 year and within 30 and 90 days.Measurements and Main Results: Four hundred twenty-two patients were included, with 132 readmitted in 1 year. Mean age was 64.8 6 11.7 years, and mean percent predicted FEV 1 was 48.1 6 18.7%. On univariate analysis, readmitted patients had lower percent predicted FEV 1 (44.9 6 17.3% vs. 50.2 6 19.4%; P = 0.05) and a higher frequency of depression (47.7% vs. 23.4%; P , 0.001). On multivariable analysis, 1-year readmission was independently associated with depression (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.59-4.47) and in-hospital tobacco cessation counseling (adjusted OR, 0.34; 95% CI, 0.18-0.66). Depression also predicted readmission at 30 days (adjusted OR, 3.83; 95% CI, 1.84-7.96) and 90 days (adjusted OR, 2.47; 95% CI, 1.34-4.55).Conclusions: Depression is an independent risk factor for both short-and long-term readmissions for acute exacerbation of COPD and may represent a modifiable risk factor. In-hospital tobacco cessation counseling was also associated with reduced 1-year readmission.

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“…La frequenza [7], la gravità [8] e il rischio di mortalità [9] correlati alle riacutizzazioni della BPCO aumentano nelle forme più gravi di malattia [10]. Nei pazienti con FEV1 > 60% (BPCO lieve-moderata) la frequenza di riacutizzazioni/anno è 1,6 rispetto a 2,6 nei pazienti con FEV1 < 40% (BPCO grave) [11], e la mortalità intraospedaliera è il 4% nei pazienti con BPCO lieve-moderata rispetto a frequenze fino al 29% nei pazienti gravi ricoverati in Unità di Terapia Intensiva (UTI) [12].…”

Section: Epidemiologiaunclassified

[Acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD)]

Urso

2017

CMI

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63toria persistente, caratterizzata da tosse con espettorazione e dispnea [4].La diagnosi di BPCO, sospettata sulla base dell'anamnesi positiva per l' esposizione a fattori di rischio (quali fumo di sigaretta e/o esposizione a inquinanti indoor e/o outdoor) e dei sintomi clinici (quali tosse con espettorazione e/o difficoltà respiratoria da sforzo e successivamente anche a riposo), è posta con l'esame spirometrico post-broncodilatazione che dimostri una limitazione al flusso aereo scarsamente reversibile (indice di Tiffenau: volume espiratorio forzato al primo secondo [FEV1]/capacità vitale [CV] < 70%) [5].La gravità della limitazione al flusso aereo (grado GOLD, Tabella I), l'intensità dei segni clinici, misurata con la scala Medical Research Council modificata (mMRC) o con il COPD Assessment Test (CAT), e la frequenza delle riacutizzazioni nei precedenti 12 IntroduzIoneLa broncopneumopatia cronica ostruttiva (BPCO) costituisce una delle principali cause di malattia, la cui prevalenza, sebbene variabile nelle diverse aree geografiche a seconda dell'esposizione ai diversi fattori di rischio [1] e dell'invecchiamento della popolazione [2], è stimata, nei soggetti ultratrentenni, pari a 11,7% [3].La BPCO è definita dalle linee guida (LG) della Global initiative for chronic Obstructive Lung Disease (GOLD) come una malattia infiammatoria cronica delle vie aeree e/o del parenchima polmonare conseguente all'esposizione a particelle nocive e gas. La limitazione al flusso aereo, scarsamente reversibile, è secondaria alla presenza di bronchiolite ostruttiva e di enfisema, variamente associati nel singolo soggetto ed è responsabile della sintomatologia respira-

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Frequent hospital readmissions for acute exacerbation of COPD and their associated factors

Abstract: Frequent past readmission for AECOPD was associated with disease severity and psychosocial distress and increased use of vaccinations.

Cited by 111 publications

References 23 publications

Serum Telomerase Levels and COPD Exacerbations

Serum Telomerase Levels and COPD Exacerbations

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

[Acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD)]

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