From the Departments of Medicine and Pulmonary and Critical Care Medicine, Baylor College of Medicine, and the Baylor College of Medicine Center of Excellence in Health Equity, Training, Houston, Texas.
South Med J. 2021 Dec;114(12):766-771. doi: 10.14423/SMJ.0000000000001329.
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and disability worldwide. Use of noninvasive ventilation (NIV) appears to be associated with a significant decrease in frequency of exacerbation, hospital admissions, and mortality in patients with COPD. In this study, we sought to determine clinical outcomes, prevalence, patient profiles and systems characteristics associated with the use of NIV in patients with asthma, bronchiectasis, and other COPD.
In this retrospective study, the Nationwide Inpatient Sample dataset was used to evaluate patient characteristics for adult hospitalizations for asthma, bronchiectasis, and other COPD between January 2002 and December 2017. Using the adjusted survey logistic regression model, the association between NIV and in-hospital mortality for asthma, bronchiectasis, and other COPD was ascertained.
Other COPD hospitalization prevalence was nearly two times higher among non-Hispanic Black patients compared with non-Hispanic White patients (8.32/1000 vs 4.46/1000). There was a 4.3% average annual decrease in the rates of NIV among hospitalized patients with other COPD during the study period. Furthermore, nonusage of NIV was associated with increased in-hospital mortality for asthma (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.50-1.57), bronchiectasis (OR 2.01, 95% CI 1.69-2.41), and other COPD (OR 1.24, 95% CI 1.16-1.32), respectively.
Inpatient use of NIV has a clear mortality benefit in asthma, bronchiectasis, and COPD. These findings support a signal for potential benefit, particularly among certain populations and warrant further investigation.
慢性阻塞性肺疾病（COPD）是全球范围内导致死亡和残疾的主要原因。使用无创通气（NIV）似乎与 COPD 患者的发作频率、住院次数和死亡率的显著降低有关。在这项研究中，我们试图确定与哮喘、支气管扩张症和其他 COPD 患者使用 NIV 相关的临床结果、患病率、患者特征和系统特征。
在这项回顾性研究中，使用全国住院患者样本数据集评估了 2002 年 1 月至 2017 年 12 月期间因哮喘、支气管扩张症和其他 COPD 住院的成年患者的特征。使用调整后的调查逻辑回归模型，确定了 NIV 与哮喘、支气管扩张症和其他 COPD 的院内死亡率之间的关系。
与非西班牙裔白人患者相比，非西班牙裔黑人患者的其他 COPD 住院患病率几乎高出两倍（8.32/1000 比 4.46/1000）。在研究期间，其他 COPD 住院患者中使用 NIV 的比率平均每年下降 4.3%。此外，对于哮喘（比值比[OR] 1.53，95%置信区间[CI] 1.50-1.57）、支气管扩张症（OR 2.01，95% CI 1.69-2.41）和其他 COPD（OR 1.24，95% CI 1.16-1.32），不使用 NIV 与住院死亡率增加相关。
在哮喘、支气管扩张症和 COPD 中，住院使用 NIV 具有明显的降低死亡率的效果。这些发现支持了潜在获益的信号，特别是在某些人群中，需要进一步研究。
