Bar-Shai Amir, Freund Ophir, Ovdat Tal, Segel Michael J, Klempfner Robert, Elis Avishay
The Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
The Israeli Center for Cardiovascular Research (ICCR) and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Front Med (Lausanne). 2023 Aug 24;10:1174148. doi: 10.3389/fmed.2023.1174148. eCollection 2023.
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Acute exacerbations of COPD (AECOPD) drastically affect the clinical course of the disease. We aimed to evaluate the treatment of AECOPD in the internal medicine departments in Israel, nationwide.
The COPD Israeli survey (COPDIS) is the first national survey of patients admitted with AECOPD to internal medicine departments between 2017 and 2019. The survey includes prospective ( = 344) and retrospective ( = 1,166) data from 13 medical centers. We analyzed the pre-hospital, in-hospital, and pre-discharge care. Hospital evaluation, outcomes and discharge recommendations were assessed as well.
The mean (±SD) age was 74 (±8) years, and 54% were males. 74% had comorbidities, and 88% had a diagnosis of COPD in their history. 70% of the patients received systemic steroids and antibiotics during their hospitalization, yet upon discharge, a lower rate of antibiotics prescription (10%) was found. Treatment with most long-acting bronchodilators dramatically dropped during admission, compared with their pre-hospital use. Overall, a long-acting bronchodilator (LABD) was used by 47% before admission, 28% in-hospital, and was prescribed to 54% at discharge. The discharge plan included a referral to pulmonary rehabilitation in only 11% and a smoking cessation recommendation in 43% of active smokers. The in-hospital mortality was 3% and the 1-year mortality rate was 25%. In multivariate analysis, performing a chest X-ray (adjusted OR 0.64, 95% CI 0.46-0.90) and prescribing LABD at discharge (AOR 0.73, 95% CI 0.57-0.95) were independent predictors for lower 1-year mortality.
Our results demonstrate AECOPD characteristics in Israel, and highlight several important gaps in AECOPD healthcare, which must be addressed to improve patient care.
慢性阻塞性肺疾病（COPD）是发病和死亡的主要原因。慢性阻塞性肺疾病急性加重（AECOPD）会严重影响疾病的临床进程。我们旨在评估以色列全国内科部门对AECOPD的治疗情况。
以色列慢性阻塞性肺疾病调查（COPDIS）是对2017年至2019年间入住内科部门的AECOPD患者进行的首次全国性调查。该调查包括来自13个医疗中心的前瞻性（=344）和回顾性（=1166）数据。我们分析了院前、院内和出院前护理情况。还评估了医院评估、结局和出院建议。
平均（±标准差）年龄为74（±8）岁，54%为男性。74%有合并症，88%既往有COPD诊断。70%的患者在住院期间接受了全身用类固醇和抗生素治疗，但出院时，抗生素处方率较低（10%）。与院前使用情况相比，大多数长效支气管扩张剂在入院期间的使用大幅下降。总体而言，47%的患者入院前使用长效支气管扩张剂（LABD），住院期间为28%，出院时处方率为54%。出院计划中，只有11%的患者被转诊至肺康复治疗，43%的现吸烟者收到戒烟建议。住院死亡率为3%，1年死亡率为25%。多因素分析中，进行胸部X光检查（调整后OR 0.64，95%CI 0.46-0.90）和出院时处方LABD（AOR 0.73，95%CI 0.57-0.95）是1年死亡率较低的独立预测因素。
我们的结果展示了以色列AECOPD的特征，并突出了AECOPD医疗保健中的几个重要差距，必须加以解决以改善患者护理。
