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Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality

INTRODUCTION: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common reason for presentation to emergency departments (ED), but the management of these episodes is often heterogeneous regardless of their potential impact on short-term adverse outcomes. METHODS: This was a l...

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Autores principales: Casas-Mendez, Fernando, Abadías, Maria Jose, Yuguero, Oriol, Bardés, Ignasi, Barbé, Ferran, de Batlle, Jordi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294427/
https://www.ncbi.nlm.nih.gov/pubmed/30550602
http://dx.doi.org/10.1371/journal.pone.0208847
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author Casas-Mendez, Fernando
Abadías, Maria Jose
Yuguero, Oriol
Bardés, Ignasi
Barbé, Ferran
de Batlle, Jordi
author_facet Casas-Mendez, Fernando
Abadías, Maria Jose
Yuguero, Oriol
Bardés, Ignasi
Barbé, Ferran
de Batlle, Jordi
author_sort Casas-Mendez, Fernando
collection PubMed
description INTRODUCTION: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common reason for presentation to emergency departments (ED), but the management of these episodes is often heterogeneous regardless of their potential impact on short-term adverse outcomes. METHODS: This was a longitudinal, retrospective study of all patients >40 years old admitted to the ED of two Spanish teaching hospitals for an AECOPD between January 1(st) and May 31(st), 2016. All data were collected from electronic medical records. The primary outcomes were patient treatment at discharge and 90-day mortality. Logistic regression was used to model the determinants of 90-day mortality. RESULTS: Of the 465 included patients, 56% were prescribed a 3-drug combination at hospital discharge, 22% a 2-drug combination, 19% a single drug, and 4% other or no treatment. Approximately 8% of patients died within 90 days after an AECOPD. Multivariate logistic models revealed that having more than 2 severe exacerbations within the last 12 months (OR (95% CI): 15.12 (4.22–54.22)) and being prescribed a single drug at discharge (OR (95% CI): 7.23 (2.44–21.38)) were the main determinants of 90-day mortality after an AECOPD. CONCLUSIONS: This study reflects the real-life heterogeneity in the pharmacological treatments prescribed after an ED admission for an AECOPD and suggests the potential impact of suboptimal inhaled treatment strategies on 90-day mortality rates.
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spelling pubmed-62944272018-12-28 Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality Casas-Mendez, Fernando Abadías, Maria Jose Yuguero, Oriol Bardés, Ignasi Barbé, Ferran de Batlle, Jordi PLoS One Research Article INTRODUCTION: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common reason for presentation to emergency departments (ED), but the management of these episodes is often heterogeneous regardless of their potential impact on short-term adverse outcomes. METHODS: This was a longitudinal, retrospective study of all patients >40 years old admitted to the ED of two Spanish teaching hospitals for an AECOPD between January 1(st) and May 31(st), 2016. All data were collected from electronic medical records. The primary outcomes were patient treatment at discharge and 90-day mortality. Logistic regression was used to model the determinants of 90-day mortality. RESULTS: Of the 465 included patients, 56% were prescribed a 3-drug combination at hospital discharge, 22% a 2-drug combination, 19% a single drug, and 4% other or no treatment. Approximately 8% of patients died within 90 days after an AECOPD. Multivariate logistic models revealed that having more than 2 severe exacerbations within the last 12 months (OR (95% CI): 15.12 (4.22–54.22)) and being prescribed a single drug at discharge (OR (95% CI): 7.23 (2.44–21.38)) were the main determinants of 90-day mortality after an AECOPD. CONCLUSIONS: This study reflects the real-life heterogeneity in the pharmacological treatments prescribed after an ED admission for an AECOPD and suggests the potential impact of suboptimal inhaled treatment strategies on 90-day mortality rates. Public Library of Science 2018-12-14 /pmc/articles/PMC6294427/ /pubmed/30550602 http://dx.doi.org/10.1371/journal.pone.0208847 Text en © 2018 Casas-Mendez et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Casas-Mendez, Fernando
Abadías, Maria Jose
Yuguero, Oriol
Bardés, Ignasi
Barbé, Ferran
de Batlle, Jordi
Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality
title Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality
title_full Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality
title_fullStr Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality
title_full_unstemmed Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality
title_short Treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: Impact on mortality
title_sort treatment strategies after acute exacerbations of chronic obstructive pulmonary disease: impact on mortality
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294427/
https://www.ncbi.nlm.nih.gov/pubmed/30550602
http://dx.doi.org/10.1371/journal.pone.0208847
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