Management of acute COPD exacerbations in the internal medicine departments in Israel–a national survey
BackgroundChronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Acute exacerbations of COPD (AECOPD) drastically affect the clinical course of the disease. We aimed to evaluate the treatment of AECOPD in the internal medicine departments in Israel, nationwide.Meth...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1174148/full |
| _version_ | 1827861033501327360 |
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| author | Amir Bar-Shai Ophir Freund Tal Ovdat Michael J. Segel Robert Klempfner Avishay Elis |
| author_facet | Amir Bar-Shai Ophir Freund Tal Ovdat Michael J. Segel Robert Klempfner Avishay Elis |
| author_sort | Amir Bar-Shai |
| collection | DOAJ |
| description | BackgroundChronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Acute exacerbations of COPD (AECOPD) drastically affect the clinical course of the disease. We aimed to evaluate the treatment of AECOPD in the internal medicine departments in Israel, nationwide.MethodsThe COPD Israeli survey (COPDIS) is the first national survey of patients admitted with AECOPD to internal medicine departments between 2017 and 2019. The survey includes prospective (n = 344) and retrospective (n = 1,166) data from 13 medical centers. We analyzed the pre-hospital, in-hospital, and pre-discharge care. Hospital evaluation, outcomes and discharge recommendations were assessed as well.ResultsThe mean (±SD) age was 74 (±8) years, and 54% were males. 74% had comorbidities, and 88% had a diagnosis of COPD in their history. 70% of the patients received systemic steroids and antibiotics during their hospitalization, yet upon discharge, a lower rate of antibiotics prescription (10%) was found. Treatment with most long-acting bronchodilators dramatically dropped during admission, compared with their pre-hospital use. Overall, a long-acting bronchodilator (LABD) was used by 47% before admission, 28% in-hospital, and was prescribed to 54% at discharge. The discharge plan included a referral to pulmonary rehabilitation in only 11% and a smoking cessation recommendation in 43% of active smokers. The in-hospital mortality was 3% and the 1-year mortality rate was 25%. In multivariate analysis, performing a chest X-ray (adjusted OR 0.64, 95% CI 0.46–0.90) and prescribing LABD at discharge (AOR 0.73, 95% CI 0.57–0.95) were independent predictors for lower 1-year mortality.ConclusionOur results demonstrate AECOPD characteristics in Israel, and highlight several important gaps in AECOPD healthcare, which must be addressed to improve patient care. |
| first_indexed | 2024-03-12T13:31:29Z |
| format | Article |
| id | doaj.art-6f4c99ca94cd4d7384b4114497fb0c1e |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-12T13:31:29Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-6f4c99ca94cd4d7384b4114497fb0c1e2023-08-24T09:24:57ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-08-011010.3389/fmed.2023.11741481174148Management of acute COPD exacerbations in the internal medicine departments in Israel–a national surveyAmir Bar-Shai0Ophir Freund1Tal Ovdat2Michael J. Segel3Robert Klempfner4Avishay Elis5The Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelThe Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelThe Israeli Center for Cardiovascular Research (ICCR) and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelInstitute of Pulmonary Medicine, Sheba Tel-Hashomer Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelThe Israeli Center for Cardiovascular Research (ICCR) and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelInternal Medicine C, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelBackgroundChronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Acute exacerbations of COPD (AECOPD) drastically affect the clinical course of the disease. We aimed to evaluate the treatment of AECOPD in the internal medicine departments in Israel, nationwide.MethodsThe COPD Israeli survey (COPDIS) is the first national survey of patients admitted with AECOPD to internal medicine departments between 2017 and 2019. The survey includes prospective (n = 344) and retrospective (n = 1,166) data from 13 medical centers. We analyzed the pre-hospital, in-hospital, and pre-discharge care. Hospital evaluation, outcomes and discharge recommendations were assessed as well.ResultsThe mean (±SD) age was 74 (±8) years, and 54% were males. 74% had comorbidities, and 88% had a diagnosis of COPD in their history. 70% of the patients received systemic steroids and antibiotics during their hospitalization, yet upon discharge, a lower rate of antibiotics prescription (10%) was found. Treatment with most long-acting bronchodilators dramatically dropped during admission, compared with their pre-hospital use. Overall, a long-acting bronchodilator (LABD) was used by 47% before admission, 28% in-hospital, and was prescribed to 54% at discharge. The discharge plan included a referral to pulmonary rehabilitation in only 11% and a smoking cessation recommendation in 43% of active smokers. The in-hospital mortality was 3% and the 1-year mortality rate was 25%. In multivariate analysis, performing a chest X-ray (adjusted OR 0.64, 95% CI 0.46–0.90) and prescribing LABD at discharge (AOR 0.73, 95% CI 0.57–0.95) were independent predictors for lower 1-year mortality.ConclusionOur results demonstrate AECOPD characteristics in Israel, and highlight several important gaps in AECOPD healthcare, which must be addressed to improve patient care.https://www.frontiersin.org/articles/10.3389/fmed.2023.1174148/fulladherence to guidelinesinternal medicinebronchodilatorshospitalexacerbation (symptom flare up)chronic obstructive pulmonary disease |
| spellingShingle | Amir Bar-Shai Ophir Freund Tal Ovdat Michael J. Segel Robert Klempfner Avishay Elis Management of acute COPD exacerbations in the internal medicine departments in Israel–a national survey Frontiers in Medicine adherence to guidelines internal medicine bronchodilators hospital exacerbation (symptom flare up) chronic obstructive pulmonary disease |
| title | Management of acute COPD exacerbations in the internal medicine departments in Israel–a national survey |
| title_full | Management of acute COPD exacerbations in the internal medicine departments in Israel–a national survey |
| title_fullStr | Management of acute COPD exacerbations in the internal medicine departments in Israel–a national survey |
| title_full_unstemmed | Management of acute COPD exacerbations in the internal medicine departments in Israel–a national survey |
| title_short | Management of acute COPD exacerbations in the internal medicine departments in Israel–a national survey |
| title_sort | management of acute copd exacerbations in the internal medicine departments in israel a national survey |
| topic | adherence to guidelines internal medicine bronchodilators hospital exacerbation (symptom flare up) chronic obstructive pulmonary disease |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1174148/full |
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