Di Chiara Claudia, Sartori Giulia, Fantin Alberto, Castaldo Nadia, Crisafulli Ernesto
Respiratory Medicine Unit, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy.
Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy.
Medicina (Kaunas). 2025 Jan 9;61(1):97. doi: 10.3390/medicina61010097.
COPD is one of the leading causes of death worldwide, so it represents a significant public health challenge. Over the years, new effective therapies have been proposed. However, the burden of COPD is still conditioned by frequent acute events defined as exacerbations (exacerbation of COPD-ECOPD), which have a significant impact not only on the patient's quality of life but also on the progression of the disease, morbidity, and mortality. Related to the severity of the condition, ECOPD may require hospital admission and often repeatedly more admissions (readmission). The phenomenon of readmissions is a significant problem, contributing substantially to the utilisation of healthcare resources and the economic burden of COPD. Related contributing factors are still poorly understood, and managing the patients readmitted to the hospital with ECOPD may be challenging. Hospital readmissions should be optimally managed, including supporting and preventive strategies. Although early readmissions (30 days from discharge) are a marker of the quality of the patient's care, we need to consider COPD patients globally. It is not sufficient to address just the acute events, so multidimensional management is necessary, able to follow the patient over time to identify, by a personalised approach, the correct treatment during and post hospitalisation and intercept any factor affecting the natural history of the disease, comprising the risk of hospital readmissions. In the context of the literature concerning respiratory medicine, particularly COPD patients, our narrative review analyses recent evidence regarding the current management of COPD hospital readmissions, aiming to propose preventive strategies helpful in clinical practice. The proposed strategies can potentially improve clinical outcomes and reduce healthcare costs when effectively implemented in practice.
慢性阻塞性肺疾病（COPD）是全球主要死因之一，因此它是一项重大的公共卫生挑战。多年来，已提出了新的有效疗法。然而，COPD的负担仍受频繁发生的急性事件（定义为急性加重，即慢性阻塞性肺疾病急性加重 - ECOPD）的制约，这些急性加重不仅对患者的生活质量有重大影响，而且对疾病的进展、发病率和死亡率也有重大影响。与病情严重程度相关，ECOPD可能需要住院治疗，而且常常需要反复多次住院（再入院）。再入院现象是一个重大问题，极大地增加了医疗资源的利用和COPD的经济负担。相关的促成因素仍了解不足，管理因ECOPD再次入院的患者可能具有挑战性。医院再入院应得到优化管理，包括支持性和预防性策略。虽然早期再入院（出院后30天内）是患者护理质量的一个指标，但我们需要从整体上考虑COPD患者。仅仅处理急性事件是不够的，因此需要进行多维度管理，能够长期跟踪患者，通过个性化方法确定住院期间和出院后的正确治疗方法，并拦截任何影响疾病自然史的因素，包括医院再入院风险。在有关呼吸医学的文献背景下，特别是COPD患者，我们的叙述性综述分析了有关COPD医院再入院当前管理的最新证据，旨在提出有助于临床实践的预防策略。所提出的策略在实际有效实施时可能会改善临床结果并降低医疗成本。
