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Volume 159, Issue 3,
, Pages 975-984
Preliminary Results of this study were presented at the American Thoracic Society 2018 International Conference, May 18-23, 2018, San Diego, CA.
Author links open overlay panelThe Canadian Respiratory Research Network
Patients admitted to the hospital with COPD are commonly managed with inhaled short-acting bronchodilators, sometimes in lieu of the long-acting bronchodilators they take as outpatients. If held on admission, these long-acting inhalers should be re-initiated upon discharge; however, health-care transitions sometimes result in unintentional discontinuation.
What is the risk of unintentional discontinuation of long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist and inhaled corticosteroid (LABA-ICS) combination medications following hospital discharge in older adults with COPD?
Study Design and Methods
A retrospective cohort study was conducted by using health administrative data from 2004 to 2016 from Ontario, Canada. Adults with COPD aged≥ 66 years who had filled prescriptions for a LAMA or LABA-ICS continuously for≥ 1 year were included. Log-binomial regression models were used to determine risk of medication discontinuation following hospitalization in each medication cohort.
Of the 27,613 hospitalization discharges included in this study, medications were discontinued 1,466 times. Among 78,953 patients with COPD continuously taking a LAMA or LABA-ICS, those hospitalized had a higher risk of having medications being discontinued than those who remained in the community (adjusted risk ratios of 1.50 [95%CI, 1.34-1.67; P< .001] and 1.62 [95%CI, 1.39, 1.90; P< .001] for LAMA and LABA-ICS, respectively). Crude rates of discontinuation for people taking LAMAs were 5.2%in the hospitalization group and 3.3%in the community group; for people taking LABA-ICS, these rates were 5.5%in the hospitalization group and 3.1%in the community group.
In an observational study of highly compliant patients with COPD, hospitalization was associated with an increased risk of long-acting inhaler discontinuation. These Results suggest a likely larger discontinuation problem among less adherent patients and should be confirmed and quantified in a prospective cohort of patients with COPD and average compliance. Quality improvement efforts should focus on safe transitions and patient medication reconciliation following discharge.
Patients and Methods
This population-based, retrospective cohort study was conducted to examine medication discontinuation following hospitalization in adults with COPD who were long-term, regular users of long-acting bronchodilators. We used linked health administrative data from April 1, 2004, to March 31, 2016, from the province of Ontario, Canada. Research ethics approval was obtained from the Sunnybrook Health Sciences Centre in Toronto (project identification number: 439-2017).
The study included 27,613 hospitalization episodes and 56,057 ED visit episodes in 78,953 highly compliant medication users with COPD. A total of 18,330 hospitalization episodes were found among 69,253 continuous users of LAMAs and 9,283 among 36,439 continuous users of LABA-ICS. Across both medication cohorts, most patients (about 51%) were between the ages of 66 and 75 years, about one-half were women, and the majority lived in urban areas. The proportion of people with COPD who had a
We conducted this observational population-based study to examine the impact of hospitalization on the continuous use of long-acting bronchodilators in adults with COPD. Our Results show that, in patients who are highly compliant users of either LAMA or LABA-ICS medications, being hospitalized was associated with an increased risk of these medications being discontinued. This finding suggests that the discontinuation rate of a COPD patient with average compliance taking medication is likely
Transitions between health-care settings may exacerbate risks to patient safety. In a large observational population-based study, we found that highly adherent older adults with COPD have an elevated risk of having their long-acting bronchodilator medications unintentionally discontinued following hospitalization. Considering the adverse health outcomes that may be associated with gaps in drug continuity, these findings underscore a need for further prospective clinical study in average, less
Author contributions: A. S. G. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. A. S. G. and R. E. M. contributed to the literature search. A. S. G., R. E. M., and D.T. contributed to the acquisition and analysis of data. A. S. G. and R. E. M. drafted the manuscript. All authors contributed to the study concept and design, interpretation of data, and the critical revision of the final manuscript.
- A.S. Gershon et al.Patient and physician factors associated with pulmonary function testing for COPD: a population study
- T. Keller et al.Association of guideline-recommended COPD inhaler regimens with mortality, respiratory exacerbations, and quality of life: a secondary analysis of the long-term oxygen treatment trial
- A.S. Gershon et al.Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study
- J.F. van Boven et al.Clinical and economic impact of non-adherence in COPD: a systematic review
- M.J. Mäkelä et al.Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD
- G. Guyatt et al.
Synthesis, grading, and presentation of evidence in guidelines: article 7 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report
Proc Am Thorac Soc
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2017 report). 2017
- J. Vestbo et al.
Adherence to inhaled therapy, mortality and hospital admission in COPDSee AlsoHow to Say I Love You in Korean: An Essential Guide to Survive in Romantic KoreaUse Google Translate with Your Smartphone Camera - The Online Momheegyu/namuwiki-extracted · Datasets at Hugging FaceCanada Visa from Nigeria - Complete Guide To Canada Visitor Visa Application And Requirements - Visa Reservation
- G.P. Velo et al.
Medication errors: prescribing faults and prescription errors
Br J Clin Pharmacol
- Y.F. Chen et al.
Prescribing errors and other problems reported by community pharmacists
Ther Clin Risk Manag
Inhaler use in hospitalized patients with chronic obstructive pulmonary disease or asthma: assessment of wasted doses
An observational study of changes to long-term medication after admission to an intensive care unit
Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases
Discontinuity of chronic medications in patients discharged from the intensive care unit
JGen Intern Med
Unintentional discontinuation of chronic medications for seniors in nursing homes: evaluation of a national medication reconciliation accreditation requirement using a population-based cohort study
The Ontario Drug Benefit Program Copayment: Its Impact on Access for Ontario Seniors and Charges to the Program
- Differences Between Men and Women with Chronic Obstructive Pulmonary Disease
2021, Clinics in Chest Medicine
Research articleLower Respiratory Tract Myeloid Cells Harbor SARS-Cov-2 and Display an Inflammatory Phenotype
Chest, Volume 159, Issue 3, 2021, pp. 963-966
Research articleOperational Challenges of a Low-Dose CT Lung Cancer Screening Program During the Coronavirus Disease 2019 Pandemic
Chest, Volume 159, Issue 3, 2021, pp. 1288-1291
Research articleA Young Girl With Bronchiectasis and Elevated Sweat Chloride
Chest, Volume 159, Issue 3, 2021, pp. e155-e158
A 14-year old girl presented with history of productive cough since the age of 3 years. For the past 6 years, she complained of chest tightness and wheezing. There was also nasal stuffiness and discharge for the past 6 years. She denied history of hemoptysis, ear discharge, or chest pain. There was no history of respiratory distress at the time of birth. Her brother also suffered from productive cough and wheezing since the age of 3 years. However, both her parents were asymptomatic.
Research articleCockroach-induced IL9, IL13, and IL31 expression and the development of allergic asthma in urban children
Journal of Allergy and Clinical Immunology, Volume 147, Issue 5, 2021, pp. 1974-1977.e3
Research articleRisk Factors of Fat Embolism Syndrome After Trauma: A Nested Case-Control Study With the Use of a Nationwide Trauma Registry in Japan
Chest, Volume 159, Issue 3, 2021, pp. 1064-1071
Fat embolism syndrome (FES) is a rare syndrome resulting from a fat embolism, which is defined by the presence of fat globules in the pulmonary microcirculation; it is associated with a wide range of symptoms.
What are the specific unknown risk factors for FES after we have controlled for basic characteristics and patient’s severity?
This was a nested case-control study that used the Japan Trauma Data Bank database from 2004 and 2017. We included patients with FES and identified patients without FES as control subjects using a propensity score matching. The primary outcome was the presence of FES during a hospital stay.
There were 209 (0.1%) patients with FES after trauma; they were compared with 2,090 matched patients from 168,835 candidates for this study. Patients with FES had long bone and open fractures in their extremities more frequently than those without FES. Regarding treatments, patients with FES received bone reduction and fixation more than those without FES. Among patients who received bone reduction and fixation, time to operation was not different between the groups (P= .63). The overall in-hospital mortality rate was 5.8%in patients with FES and 3.4%in those without FES (P= .11). Conditional logistic regression models to identify risk factors associated with FES shows long bone and open fractures in extremities injury were associated with FES. Primary bone reduction and fixation was not associated independently with FES (OR, 1.80; 95%CI, 0.92-3.54), but delay time to the operation was associated with FES (OR, 2.21; 95%CI, 1.16-4.23).
Long bone and open fractures in injuries to the extremities were associated with FES. Although bone reduction and fixation were not associated with FES, delay time to the operation was associated with FES.
Research articleSepsis, the Administration of IV Fluids, and Respiratory Failure: A Retrospective Analysis—SAIFR Study
Chest, Volume 159, Issue 4, 2021, pp. 1437-1444
Although resuscitation with IV fluids is the cornerstone of sepsis management, consensus regarding their association with improvement in clinical outcomes is lacking.
Is there a difference in the incidence of respiratory failure in patients with sepsis who received guideline-recommended initial IV fluid bolus of 30mL/kg or more conservative resuscitation of less than 30mL/kg?
This was a retrospective analysis of prospectively collected clinical data conducted at an academic medical center in Omaha, Nebraska. We abstracted data from 214 patients with sepsis admitted to a single academic medical center between June 2017 and June 2018. Patients were stratified by receipt of guideline-recommended fluid bolus. The primary outcome was respiratory failure defined as an increase in oxygen flow rate or more intense oxygenation and ventilation support; oxygen requirement and volume were measured at admission, 6 h, 12 h, 24 h, and at discharge. Subgroup analyses were conducted in high-risk patients with congestive heart failure (CHF) as well as those with chronic kidney disease (CKD).
A total of 62 patients (29.0%) received appropriate bolus treatment. The overall rate of respiratory failure was not statistically different between patients who received appropriate bolus or did not (40.3%vs36.8%; P= .634). Likewise, no differences were observed in time to respiratory failure (P= .645) or risk of respiratory failure (adjusted hazard ratio, 1.1 [95%CI, 0.7-1.7]; P= .774). Results were similar within the high-risk CHF and CKD subgroups.
In this single-center retrospective study, we found that by broadly defining respiratory failure as an increase in oxygen requirements, a conservative initial IV fluid resuscitation strategy did not correlate with decreased rates of hypoxemic respiratory failure.
FUNDING/SUPPORT: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. This study also received funding from the Canadian Respiratory Research Network (CRRN). Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health and Long-Term Care and the Canadian Institute of Health Information. The CRRN is supported by grants from the Canadian Institutes of Health Research-Institute of Circulatory and Respiratory Health; Canadian Lung Association/Canadian Thoracic Society; British Colombia Lung Association; and industry partners Boehringer-Ingelheim Canada Ltd., AstraZeneca Canada Inc., and Novartic Canada Ltc. Funding for training of graduate students and new investigators within the CRRN was supported by the aforementioned funding sponsors and as well by GlaxoSmithKline Inc.
© 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.