Variability of blood eosinophil count and prognosis of COPD exacerbations

MPOC; Eosinofília; ExacerbacióEPOC; Eosinofilia; ExacerbaciónCOPD; Eosinophilia; ExacerbationBackground Eosinophils in peripheral blood are one of the emerging biomarkers in chronic obstructive pulmonary disease (COPD) patients. However, when analysing the relationship between peripheral eosinophilia and COPD prognosis, highly variable results are obtained. The aim of our study is to describe the serum eosinophilia levels in COPD patients and to analyse their relationship to prognosis following hospital admission. Methods A prospective observational study was conducted from 1 October 2016 to 1 October 2018 in the following Spanish centres: Salnés County Hospital in Vilagarcía de Arousa, Arquitecto Marcide Hospital in Ferrol and the University Hospital Complex in Santiago de Compostela. The patients were classified using three cut-off points of blood eosinophil count (BEC): 150 cells/µL, 300 cells/µL, and 400 cells/µL; in addition, the peripheral BEC was analysed on admission. Results 615 patients were included in the study, 86.2% male, mean age 73.9 years, and mean FEV1 52.7%. The mean stay was 8.4 days, and 6% of all patients were readmitted early. No significant relationship was observed between the BEC, neither in the stable phase nor in the acute phase, and hospital stay, readmissions, deaths during admission, the need for intensive care, or the condition of frequent exacerbator. Conclusion The results of our study do not seem to support the usefulness of BEC as a COPD biomarker.This paper has not been funded by any project or scholarship

Impact of a home telehealth program after a hospitalized COPD exacerbation: a propensity score analysis

[Abstract] Introduction: Currently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization. Objective: To demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting. Methods: This is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission. Results: The analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI=0.56-0.91] 0.71 [95% CI=0.56-0.91; p=0.007). This benefit was maintained after the propensity score analysis (HR=0.66 [95% CI=0.51-0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR=0.54; 95% CI=[0.36-0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI=[0.50-0.86]) are analyzed separately. Conclusion: Telemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting

Análisis de los ingresos hospitalarios por asma: características y factores pronóstico

El asma es una enfermedad inflamatoria crónica de las vías respiratorias que se caracteriza por la aparición de episodios recurrentes y variables en su intensidad de síntomas respiratorios (tos, sibilancias, opresión torácica, disnea…), limitación al flujo aéreo e hiperreactividad bronquial, teniendo como sustrato patológico la presencia de inflamación a nivel bronquial. Se considera el asma un problema de salud pública que afecta a 300 millones de personas en el mundo, si bien se ha constatado en los últimos años una reducción en la mortalidad debida a esta enfermedad sigue siendo una importante causa de absentismo laboral y una carga socioeconómica para los que la padecen. Los objetivos de nuestro estudio son determinar la incidencia de ingresos hospitalarios por asma en nuestra área sanitaria, analizar las características de los pacientes ingresados en el hospital por agudización asmática, evaluar los resultados de los ingresos hospitalarios por asma en cuanto a estancia hospitalaria, reingresos y mortalidad, determinar los factores relacionados con mayor probabilidad de reingreso hospitalario por agudización asmática y analizar los episodios de asma de riesgo vital. Con esta finalidad hemos revisado retrospectivamente todos los ingresos por agudización de asma producidos en nuestro hospital entre el 1 de enero del año 2000 y el 31 de diciembre del año 2010, en mayores de 18 años, de acuerdo con los registros del Servicio de Documentación Clínica de nuestro hospital. De estos pacientes se examinaron varias de sus características (edad, sexo, IMC, tratamiento de base..), realizando especial hincapié en si los pacientes habían precisado reingresos (ya fuesen éstos precoces o tardíos) y si habían presentado episodios de asma de riesgo vital. En nuestro estudio parece observarse una tendencia al incremento del número de ingresos hospitalarios en los últimos años, al contrario de lo observado en otros estudios realizados en países occidentales. También hemos objetivado que en nuestra población, un 24% de los paciente ha precisado ingresos hospitalarios repetidos a lo largo de los 11 años del estudio. Asimismo hemos constatado que los episodios de asma de riesgo vital fueron relativamente comunes en nuestra población de estudio: durante 11 años identificamos 400 episodios, representando el 19% de todos los ingresos por asma en nuestro hospital. En conclusión, el manejo del asma en nuestra población nos parece mejorable, tanto de forma ambulatoria como durante el ingreso hospitalario

La obesidad no aumenta el riesgo de reingresos de asma

The relationship between obesity and asthma exacerbations is still under debate. The aim of our work is to analyse the relationship between obesity and hospital re-admissions in asthmatics. A review was retrospectively performed on all hospital admissions of adult patients due to asthma exacerbation occurring in our hospital for 11 years. All those cases with asthma as the first diagnosis in the discharge report were included, or those with asthma as the second diagnosis provided when the first diagnosis was respiratory infection or respiratory failure. Only the first hospital admission of each patient was included in this study. The Odds Ratios of a higher incidence of early/late readmissions due to asthma exacerbation were calculated using a binary logistic regression, using the body mass index (BMI) as independent variable, adjusted for all the variables included in the study. The study included 809 patients with a mean age of 55.6 years, and 65.2% were female. The majority (71.4%) were obese or overweight. No significant relationship was observed in the univariate or multivariate analyses between overweight or obesity and the early or late hospital readmissions due to asthma. Therefore, obesity does not seem to be a determining factor in the risk of asthma exacerbations.S