Hospitalized Patients with COPD Plus Comorbid Conditions Are Undertreated

Patients with chronic obstructive pulmonary disease and who have other comorbid conditions are undertreated when hospitalized for exacerbations, study finds.

Hospital readmissions are a cause of morbidity and mortality among patients with chronic obstructive pulmonary disease (COPD); however, it is unknown how such comorbidities affect treatment choices. Recent research suggested that comorbidity was associated with 30-day readmission and mortality, and with delivery of fewer treatments known to be beneficial among patients with COPD.

The study involved veterans hospitalized with a COPD exacerbation among 6 Veterans Affairs hospitals between 2005 to 2011. The researchers collected data of the comorbidities during the year before hospitalization. Also, the Deyo-Charlson index was used to measure the burden of comorbidity.

“We defined the primary outcome as all-cause mortality or readmission within thirty days of discharge from index hospitalization,” the authors stated. “We also sought to examine whether comorbidity would be associated with delivery of systemic corticosteroids and antibiotics during the index hospital admission, two therapies that are generally recommended for treatment of COPD exacerbations among hospitalized patients.”

In total, 2391 patients were included in the study. The researchers found that each 1-point increase in the Charlson index was associated with greater odds of readmission or death, yet had reduced odds of receiving treatment with steroids and antibiotics. Additionally, patients with comorbid congestive heart failure, coronary artery disease, and chronic kidney disease were less likely to receive corticosteroids and antibiotic treatment than those without those specific comorbidities.

Click to continue reading on The American Journal of Managed Care.