Reducing Readmission for Acute Exacerbation of COPD
This report is important but limited by being a retrospective analysis. Nevertheless, it raises an important concept—early communication with the patient following an AECOPD. An AECOPD is defined as an increase in the symptoms of COPD beyond the patient's normal level of symptoms that leads to a change in medication. AECOPDs occur on average once yearly, primarily in patients with severe or very severe COPD. These are extremely important events because they negatively affect patients' quality of life. Recovery can take several weeks, and many patients fail to return to their previous quality of life. AECOPDs also accelerate the rate of decline of lung function and not infrequently result in mortality. Moreover, AECOPDs account for one third to three fourths of the overall cost of care for COPD, particularly when the patient requires admission to the hospital. For all of these reasons, it is important to do whatever we can to reduce the frequency and severity of these dangerous events.
It has been well authenticated that some of the pharmacologic agents used for maintenance therapy in stable COPD—particularly long-acting bronchodilators with both beta-adrenergic and anticholinergic mechanisms—can also reduce the frequency of recurrent events. Short-acting bronchodilators do not share this ability. Inhaled glucocorticoids reduce the frequency of AECOPD, and roflumilast (Daliresp®) is approved specifically for this purpose. Low-dose azithromycin (250 mg once daily) may also reduce the frequency of AECOPD. Smoking cessation should be strongly urged for patients who still smoke. Furthermore, clinicians should stress the importance of annual influenza vaccination and pneumococcal vaccination once or twice per lifetime and instruct patients in the appropriate use of inhaled and oral medications. Pulmonary rehabilitation, where available, is also recommended.
To this list of modalities aimed at reducing the risk for readmission to the hospital for AECOPD, we should add early follow-up with the patient following discharge. A previous large, similar study came to the same conclusion. However, the point bears repeating. The follow-up visit maintains communication with the patient and continuity of treatment, permitting the clinician to address any residual issues that the patient may have as well as any barriers to the patient's compliance with treatments.
Viewpoint
This report is important but limited by being a retrospective analysis. Nevertheless, it raises an important concept—early communication with the patient following an AECOPD. An AECOPD is defined as an increase in the symptoms of COPD beyond the patient's normal level of symptoms that leads to a change in medication. AECOPDs occur on average once yearly, primarily in patients with severe or very severe COPD. These are extremely important events because they negatively affect patients' quality of life. Recovery can take several weeks, and many patients fail to return to their previous quality of life. AECOPDs also accelerate the rate of decline of lung function and not infrequently result in mortality. Moreover, AECOPDs account for one third to three fourths of the overall cost of care for COPD, particularly when the patient requires admission to the hospital. For all of these reasons, it is important to do whatever we can to reduce the frequency and severity of these dangerous events.
It has been well authenticated that some of the pharmacologic agents used for maintenance therapy in stable COPD—particularly long-acting bronchodilators with both beta-adrenergic and anticholinergic mechanisms—can also reduce the frequency of recurrent events. Short-acting bronchodilators do not share this ability. Inhaled glucocorticoids reduce the frequency of AECOPD, and roflumilast (Daliresp®) is approved specifically for this purpose. Low-dose azithromycin (250 mg once daily) may also reduce the frequency of AECOPD. Smoking cessation should be strongly urged for patients who still smoke. Furthermore, clinicians should stress the importance of annual influenza vaccination and pneumococcal vaccination once or twice per lifetime and instruct patients in the appropriate use of inhaled and oral medications. Pulmonary rehabilitation, where available, is also recommended.
To this list of modalities aimed at reducing the risk for readmission to the hospital for AECOPD, we should add early follow-up with the patient following discharge. A previous large, similar study came to the same conclusion. However, the point bears repeating. The follow-up visit maintains communication with the patient and continuity of treatment, permitting the clinician to address any residual issues that the patient may have as well as any barriers to the patient's compliance with treatments.
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