Hospital Care of Older Patients With COPD: Adherence to International Guidelines for Use of Inhaled Bronchodilators and Corticosteroids

Abstract

Keywords:COPD older patients guidelines adherence major clinical events a b s t r a c tObjectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged 65 years. Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results: At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD guidelines. Polypharmacy (5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95% CI: 0.02-0.90). Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status.

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

“…The use of BBs was evaluated in hospitalized older patients affected by HF and COPD to implement the knowledge about the management of older patients enrolled in the REPOSI database ( 39 , 40 ). First, HF prevalence was higher than in previous studies ( 41 – 43 ) because of the selection of a different population and diagnostic criteria ( 44 ).…”

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry

“…Clinical characteristics and health outcomes have been widely investigated for many diseases [5][6][7][8], but specific data on older patients admitted to hospital with a diagnosis of liver cirrhosis (LC) are sparse [9][10][11][12][13]. LC is a worldwide challenge frequently leading to physical disability, hospitalisation and mortality, but the relatively low prevalence of LC in older in-patients (from 2% to 10%) [10,11,13,14] has probably prioritised more prevalent and highly impacting diseases such as congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) [5,6,15]. Notwithstanding, results from previous studies suggest that, even if relatively less prevalent, LC is prognostically relevant, both in absolute terms and in comparison with other highly impacting diseases [9][10][11][12][13].…”

Influence of Physician Sex and Gender on Prescribing Practices Among Older Adults

“…Despite this, evidence suggests that recommendations are infrequently adopted in clinical practice and that guideline adherence may be influenced by physician sex. [23][24][25][26][27][28] For example, patients treated by female physicians tend to achieve treatment goals more frequently recommended in clinical guidelines than those treated by male physicians. [29][30][31] Female physicians were also shown to be more likely to intensify medication therapies in people with type 2 diabetes mellitus in an effort to achieve recommended cardiovascular disease targets.…”