Impact of Chronic Obstructive Pulmonary Disease Home and Discharge Inhaler Regimens on Exacerbation Severity and Hospital Readmission

Purpose:

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are the standard for diagnosing and treating chronic obstructive pulmonary disease (COPD). According to GOLD, long-acting muscarinic antagonists (LAMA) should be the backbone of COPD management. Studies have shown patients with COPD who are treated with a LAMA experience a reduction in COPD exacerbations. The purpose of this study is to identify the impact of home inhalers for COPD on inpatient (non-critically ill) exacerbation severity and to analyze changes in COPD regimens following an exacerbation and the subsequent impact on hospital readmission.

Methods:

This study was a retrospective, observational, cohort study conducted at a community teaching hospital. Adult patients were included if they were admitted for a COPD exacerbation from 2018 to 2021. Patients were excluded if they had other respiratory disorders, infiltrates on chest X-ray, were on vasopressors, mechanical ventilation, or pregnant. Patients’ home, inpatient, and discharge medications for COPD (i.e. inhalers), readmission rates, and time to hospital readmission were extracted from the electronic medical record along with other baseline characteristics and laboratory values. Each patient was evaluated on their at-home medication regimen and placed into an inhaler treatment category (e.g. LAMA only, LAMA + LABA, etc.). The primary outcome of the study was to determine the rate of severe COPD exacerbations as stratified by at-home COPD inhaler regimen. Secondary outcomes include the readmission rate, time to readmission, and the percentage of patients with guideline directed LAMA added to therapy. The chi-square test was used to measure outcomes of categorical data, including association of medication regimen and COPD severity. An unpaired t-test was used to compare the impact of discharge inhaler regimens on time to hospital readmission. A two-way loglinear analysis was completed to analyze the association of home inhalers on severity of COPD exacerbation as well as the association of discharge inhaler on hospital readmission.

Results:

A total of 288 patients were included in the study. No association was found between home inhaler regimen and patients admitted with severe versus non-severe COPD exacerbation. There was also no association identified between discharge medications and hospital readmission rates, with the exception of the LAMA only group, which did show there was a significant decrease in readmission rate compared to other groups (18.2% vs. 81.8%) (p=0.05). Finally, there was no association between the categories of home inhalers on severity of COPD exacerbation or time to readmission. A total 21 patients were previously not on a LAMA and had a LAMA added to their therapy at discharge (9.9%).

Conclusion:

No association was found between the majority of home or discharge inhaler regiments and defined outcomes, with the exception of patients discharging on a LAMA only had a lower readmission rate. There was also an increase in patients with a LAMA containing regimen at discharge, which is consistent with the GOLD guideline recommendations.