How may we improve clinical outcomes for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease? A narrative review about possible therapeutic and preventive strategies

ABSTRACT Introduction: In a subset of chronic obstructive pulmonary disease (COPD)patients the course of the disease is complicated by a severe acute exacerbations (AECOPD) that may require hospitalization, at which time negative outcomes may occur up to 30 days after discharge. Several predictors of negative outcomes have been documented. Areas covered: We considered five negative outcomes related to patients hospitalized with AECOPD: treatment failure, noninvasive mechanical ventilation (NIMV) failure, prolonged length of hospital stay (LHS), short-term mortality (≤ 90 days from admission and including the in-hospital mortality), and early readmission (≤30 days from discharge). Possible therapeutic and preventive strategies to improve these outcomes are outlined and discussed. Expert opinion: Several strategies have been proposed to improve outcomes. Among these, steroid or antibiotic use may reduce the risks of treatment failure or of prolonged hospital stay. We note that operator-related factors may influence the outcome of NIMV. However, little has been documented about the short-term mortality or early readmission rates. In general, few interventions consistently improve negative outcomes and prognosis of AECOPD.

[1]  G. Verleden,et al.  Azithromycin during Acute COPD Exacerbations Requiring Hospitalization (BACE): a Multicentre, Randomized, Double-blind, Placebo-controlled Trial. , 2019, American journal of respiratory and critical care medicine.

[2]  Procalcitonin-guided antibiotic therapy in acute exacerbation of chronic obstructive pulmonary disease , 2019, Medicine.

[3]  J. Vestbo,et al.  Eosinophil-guided corticosteroid therapy in patients admitted to hospital with COPD exacerbation (CORTICO-COP): a multicentre, randomised, controlled, open-label, non-inferiority trial. , 2019, The Lancet. Respiratory medicine.

[4]  A. Torres,et al.  Hospitalized acute exacerbations of chronic obstructive pulmonary disease: which patients may have a negative clinical outcome? , 2019, Expert review of respiratory medicine.

[5]  A. Turner,et al.  Temporal trends in survival following ward‐based NIV for acute hypercapnic respiratory failure in patients with COPD , 2019, The clinical respiratory journal.

[6]  P. Ho,et al.  Impact of Macrolide Antibiotics on Hospital Readmissions and Other Clinically Important Outcomes in Critically Ill Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Propensity Score–Matched Cohort Study , 2019, Pharmacotherapy.

[7]  A. Cuvelier,et al.  Efficacy of a home discharge care bundle after acute exacerbation of COPD , 2019, International journal of chronic obstructive pulmonary disease.

[8]  D. Fernandes,et al.  The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease. , 2019, Diabetes & metabolic syndrome.

[9]  S. Flanders,et al.  Introduction of Procalcitonin Testing and Antibiotic Utilization for Acute Exacerbations of Chronic Obstructive Pulmonary Disease , 2019, Infectious diseases.

[10]  A. Chetta,et al.  Clinical variables predicting the risk of a hospital stay for longer than 7 days in patients with severe acute exacerbations of chronic obstructive pulmonary disease: a prospective study , 2018, Respiratory Research.

[11]  A. Chetta,et al.  Looking for Predictors of Early Readmission in Chronic Obstructive Pulmonary Disease: Every Effort Is Required. , 2018, Annals of the American Thoracic Society.

[12]  P. Sundaragiri,et al.  Role of B-Type Natriuretic Peptide in Predicting In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease With Preserved Left Ventricular Function: A 5-Year Retrospective Analysis , 2018, Journal of intensive care medicine.

[13]  A. Torres,et al.  Management of severe acute exacerbations of COPD: an updated narrative review , 2018, Multidisciplinary Respiratory Medicine.

[14]  D. Au,et al.  Quality of Care Delivered to Veterans with COPD Exacerbation and the Association with 30-Day Readmission and Death , 2018, COPD.

[15]  R. Tiruvoipati,et al.  Factors associated with hospital mortality in critically ill patients with exacerbation of COPD , 2018, International journal of chronic obstructive pulmonary disease.

[16]  J. Wells,et al.  The use of a standardized order set reduces systemic corticosteroid dose and length of stay for individuals hospitalized with acute exacerbations of COPD: a cohort study , 2018, International journal of chronic obstructive pulmonary disease.

[17]  A. Torres,et al.  Microorganisms resistant to conventional antimicrobials in acute exacerbations of chronic obstructive pulmonary disease , 2018, Respiratory Research.

[18]  M. Ospina,et al.  Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease , 2018, BMC Pulmonary Medicine.

[19]  E. Clini,et al.  Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation , 2018, Critical Care.

[20]  A. Anzueto,et al.  Treatment of exacerbations as a predictor of subsequent outcomes in patients with COPD , 2018, International journal of chronic obstructive pulmonary disease.

[21]  A. Duggal,et al.  Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD) , 2018, Medicine.

[22]  M. Etminan,et al.  The association between previous and future severe exacerbations of chronic obstructive pulmonary disease: Updating the literature using robust statistical methodology , 2018, PloS one.

[23]  J. Cury,et al.  Operator dependent factors implicated in failure of non‐invasive positive pressure ventilation (NIPPV) for respiratory failure , 2017, The clinical respiratory journal.

[24]  Michel Wolff,et al.  Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. , 2017, The Cochrane database of systematic reviews.

[25]  M. Mantero,et al.  Acute exacerbations of COPD: risk factors for failure and relapse , 2017, International journal of chronic obstructive pulmonary disease.

[26]  G. La Torre,et al.  Chronic obstructive pulmonary disease (COPD) exacerbation: impact of comorbidities on length and costs during hospitalization. , 2017, European review for medical and pharmacological sciences.

[27]  Joanna Picot,et al.  Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. , 2017, The Cochrane database of systematic reviews.

[28]  A. Forster,et al.  Factors contributing to high-cost hospital care for patients with COPD , 2017, International journal of chronic obstructive pulmonary disease.

[29]  John R. Hurst,et al.  Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline , 2017, European Respiratory Journal.

[30]  M. R. Siddiqui,et al.  Global Initiative for Chronic Obstructive Lung Disease (GOLD) , 2017 .

[31]  J. Vestbo,et al.  Procalcitonin to guide antibiotic administration in COPD exacerbations: a meta-analysis , 2017, European Respiratory Review.

[32]  S. Ladelund,et al.  Nurse-initiated telephone follow-up on patients with chronic obstructive pulmonary disease improves patient empowerment, but cannot prevent readmissions. , 2016, Danish medical journal.

[33]  V. Press,et al.  COPD Readmissions: Addressing COPD in the Era of Value-based Health Care. , 2016, Chest.

[34]  S. Mojal,et al.  Impact of hyponatremia on mortality and morbidity in patients with COPD exacerbations. , 2016, Respiratory medicine.

[35]  B. Ergan,et al.  Impact of anemia on short-term survival in severe COPD exacerbations: a cohort study , 2016, International journal of chronic obstructive pulmonary disease.

[36]  P. Sundaragiri,et al.  Influence of Left Ventricular Hypertrophy on In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease , 2016, COPD.

[37]  B. Cao,et al.  Acute exacerbations of chronic obstructive pulmonary disease with low serum procalcitonin values do not benefit from antibiotic treatment: a prospective randomized controlled trial. , 2016, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[38]  A. Chetta,et al.  Readmission in COPD patients: should we consider it a marker of quality of care or a marker of a more severe disease with a worse prognosis? , 2016, European Respiratory Journal.

[39]  Beth M DeRonne,et al.  Order Set to Improve the Care of Patients Hospitalized for an Exacerbation of Chronic Obstructive Pulmonary Disease. , 2016, Annals of the American Thoracic Society.

[40]  R. Tandon,et al.  COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates , 2016, International journal of chronic obstructive pulmonary disease.

[41]  Antoni Torres,et al.  Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study , 2016, PloS one.

[42]  D. Sin,et al.  Impact of individualized care on readmissions after a hospitalization for acute exacerbation of COPD , 2016, International journal of chronic obstructive pulmonary disease.

[43]  J. Wedzicha,et al.  Predicting In-Hospital Treatment Failure (≤7 days) in Patients with COPD Exacerbation Using Antibiotics and Systemic Steroids , 2016, COPD.

[44]  I. Arostegui,et al.  A decision tree to assess short-term mortality after an emergency department visit for an exacerbation of COPD: a cohort study , 2015, Respiratory Research.

[45]  S. Fagnani,et al.  Erdosteine reduces inflammation and time to first exacerbation postdischarge in hospitalized patients with AECOPD , 2015, International journal of chronic obstructive pulmonary disease.

[46]  W. Kim,et al.  Early failure of noninvasive ventilation in chronic obstructive pulmonary disease with acute hypercapnic respiratory failure , 2015, Internal and Emergency Medicine.

[47]  A. Torres,et al.  Predictors of Readmission in a Period of 30 Days or Less in Acute Exacerbation of Chronic Obstructive Pulmonary Disease , 2015 .

[48]  A. Liapikou,et al.  C-Reactive Protein at Discharge, Diabetes Mellitus and ≥1 Hospitalization During Previous Year Predict Early Readmission in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease , 2015, COPD.

[49]  C. Millett,et al.  Impact of a COPD Discharge Care Bundle on Readmissions following Admission with Acute Exacerbation: Interrupted Time Series Analysis , 2015, PloS one.

[50]  M. Yigla,et al.  D-dimer as a Prognostic Biomarker for Mortality in Chronic Obstructive Pulmonary Disease Exacerbation , 2015, The American journal of the medical sciences.

[51]  N. González,et al.  Predictors of Hospital Length of Stay in Patients with Exacerbations of COPD: A Cohort Study , 2015, Journal of General Internal Medicine.

[52]  A. Nicolini,et al.  Open-Mouthpiece Ventilation Versus Nasal Mask Ventilation in Subjects With COPD Exacerbation and Mild to Moderate Acidosis: A Randomized Trial , 2014, Respiratory Care.

[53]  Konstantinos Kostikas,et al.  Prediction of Hospitalization Stay in COPD Exacerbations: The AECOPD-F Score , 2014, Respiratory Care.

[54]  G. Cesana,et al.  The Clinical and Economic Impact of Exacerbations of Chronic Obstructive Pulmonary Disease: A Cohort of Hospitalized Patients , 2014, PloS one.

[55]  J. Woods,et al.  Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease , 2014, International journal of chronic obstructive pulmonary disease.

[56]  R. Vandivier,et al.  Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease. , 2014, American journal of respiratory and critical care medicine.

[57]  Mark V. Williams,et al.  Interventions to reduce rehospitalizations after chronic obstructive pulmonary disease exacerbations. A systematic review. , 2014, Annals of the American Thoracic Society.

[58]  E. Ozyilmaz,et al.  Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies , 2014, BMC Pulmonary Medicine.

[59]  S. Sethi,et al.  Role of Infections , 2014, Clinics in Chest Medicine.

[60]  Knut Stavem,et al.  Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD) , 2014, International journal of chronic obstructive pulmonary disease.

[61]  J. Walters,et al.  Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. , 2003, The Cochrane database of systematic reviews.

[62]  F. Dachraoui,et al.  Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation , 2013, European Respiratory Journal.

[63]  M. Briel,et al.  Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. , 2013, JAMA.

[64]  James D. Chalmers,et al.  Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. , 2013, Annals of the American Thoracic Society.

[65]  S. Suissa,et al.  Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality , 2012, Thorax.

[66]  C. Agustí,et al.  Sputum purulence-guided antibiotic use in hospitalised patients with exacerbations of COPD , 2012, European Respiratory Journal.

[67]  A. Anzueto,et al.  Efficacy of corticosteroid therapy in patients with an acute exacerbation of chronic obstructive pulmonary disease receiving ventilatory support. , 2011, Archives of internal medicine.

[68]  S. Nava,et al.  Optimization of ventilator setting by flow and pressure waveforms analysis during noninvasive ventilation for acute exacerbations of COPD: a multicentric randomized controlled trial , 2011, Critical care.

[69]  Qiao-ying Yuan,et al.  Bacteriological Differences Between COPD Exacerbation and Community-Acquired Pneumonia , 2011, Respiratory Care.

[70]  W. Zin,et al.  Comparison of Noninvasive Ventilation by Sequential Use of Mask and Helmet versus Mask in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Preliminary Study , 2011, Respiration.

[71]  F. Abroug,et al.  Standard versus newer antibacterial agents in the treatment of severe acute exacerbation of chronic obstructive pulmonary disease: a randomized trial of trimethoprim-sulfamethoxazole versus ciprofloxacin. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[72]  R. Hoogenveen,et al.  Case fatality of COPD exacerbations: a meta-analysis and statistical modelling approach , 2010, European Respiratory Journal.

[73]  C. Roussos,et al.  Predictors of Outcome After Exacerbation of Chronic Obstructive Pulmonary Disease , 2009, Journal of General Internal Medicine.

[74]  T. Murphy,et al.  Infection in the pathogenesis and course of chronic obstructive pulmonary disease. , 2008, The New England journal of medicine.

[75]  D. Postma,et al.  Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. , 2007, Chest.

[76]  B. Celli,et al.  Exacerbations of chronic obstructive pulmonary disease , 2007, European Respiratory Journal.

[77]  R. Rodríguez-Roisín,et al.  Antibiotics for exacerbations of chronic obstructive pulmonary disease. , 2011, The Cochrane database of systematic reviews.

[78]  M. Decramer,et al.  Integrated care prevents hospitalisations for exacerbations in COPD patients , 2006, European Respiratory Journal.

[79]  Thierry Troosters,et al.  Physical activity and hospitalization for exacerbation of COPD. , 2006, Chest.

[80]  T. Kwok,et al.  A Randomized, Controlled Trial of an Intensive Community Nurse–Supported Discharge Program in Preventing Hospital Readmissions of Older Patients with Chronic Lung Disease , 2004, Journal of the American Geriatrics Society.

[81]  I. Stiell,et al.  Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. , 2003, The New England journal of medicine.

[82]  B. Grant,et al.  New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. , 2002, The New England journal of medicine.

[83]  S Pita,et al.  Factors predicting a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease , 2002, Journal of internal medicine.

[84]  L. Davies,et al.  Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial , 1999, The Lancet.

[85]  D. Niewoehner,et al.  Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. , 1999, The New England journal of medicine.