title: Emergency Hospital Care for Exacerbation of COPD: Is Inhaled Maintenance Therapy Modified?
abstract: BACKGROUND
  The impact of hospital emergency care and inward admission for acute exacerbations of COPD on inhaled maintenance treatment is not well known.
  
  
  OBJECTIVE
  Therefore, we evaluated the impact of short-stay emergency hospital care and inward admission for acute exacerbation of COPD (eCOPD) on inhaled maintenance treatment prescribed at discharge.
  
  
  METHODS
  Prospective observational cohort study of patients presenting with eCOPD at emergency departments in 16 hospitals of the Spanish healthcare system. The ethics committee at each hospital approved the study and patients provided an informed consent before inclusion. We classified the patients according to the severity of COPD: mild/moderate (FEV1 ≥ 50% predicted) or severe/very severe (FEV1 < 50% predicted) and need of inward hospitalisation. We analysed changes to maintenance treatment on discharge according to GOLD strategy.
  
  
  RESULTS
  1559 patients, 65% required hospitalisation. The most common maintenance treatment was inhaled corticoids (ICS) (80.9%) followed by long-acting beta-agonists (LABA) (75.4%). The most common combination was triple therapy (LABA+ LAMA+ICS) (56.2%) followed by LABA+ICS dual therapy (18.2%) regardless of the severity of COPD. In more than 60% of patients treatment was not changed at discharge. The most common change in treatment was a reduction when discharge was from emergency care and an increase after hospitalisation (-21.6% and +19.5% in severe/very severe COPD, respectively).
  
  
  CONCLUSIONS
  Emergency hospital care for eCOPD does not usually induce changes in inhaled maintenance treatment for COPD regardless of the duration of the hospital stay.
authors.affiliation: a Department of Respiratory Medicine , Parc Taulí Sabadell - University Hospital , Sabadell , Spain.|b Universitat Autònoma de Barcelona , Esfera UAB , Barcelona , Spain.|j Multidisciplinary and Multi-Institutional Research Network in Respiratory Diseases-CIBERES, Instituto de Salud Carlos III (ISCIII) , Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pomares
authors.affiliation: a Department of Respiratory Medicine , Parc Taulí Sabadell - University Hospital , Sabadell , Spain.|i Health Services Research on Chronic Diseases Network- REDISSEC , Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Montón
authors.affiliation: c Clinical Epidemiology , Parc Taulí Sabadell - University Hospital , Sabadell , Spain.|d Obstetrics, Gynecology and Preventive Medicine Department , Universitat Autònoma de Barcelona-UAB, Bellaterra , Barcelona , Spain.|i Health Services Research on Chronic Diseases Network- REDISSEC , Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Baré
authors.affiliation: c Clinical Epidemiology , Parc Taulí Sabadell - University Hospital , Sabadell , Spain.|i Health Services Research on Chronic Diseases Network- REDISSEC , Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Pont
authors.affiliation: e Pulmonology Department, Hospital del Mar - IMIM. CEXS , Universitat Pompeu Fabra , Barcelona , Catalonia , Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Estirado
authors.affiliation: e Pulmonology Department, Hospital del Mar - IMIM. CEXS , Universitat Pompeu Fabra , Barcelona , Catalonia , Spain.|j Multidisciplinary and Multi-Institutional Research Network in Respiratory Diseases-CIBERES, Instituto de Salud Carlos III (ISCIII) , Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gea
authors.affiliation: f Research Unit, Galdakao Hospital , Bilbao , Spain.|i Health Services Research on Chronic Diseases Network- REDISSEC , Spain.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Quintana
authors.affiliation: g Research Unit, Hospital Costa del Sol , Marbella , Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Vidal
authors.affiliation: h Pulmonology Department. Hospital , La Paz . Madrid , Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Santiago
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D005541:Forced Expiratory Volume; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization; D006779:Hospitals, Public; D006801:Humans; D007902:Length of Stay; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010351:Patient Discharge; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index; D013030:Spain
chemical_list: D000318:Adrenergic beta-Agonists; D005938:Glucocorticoids; D018727:Muscarinic Antagonists
keywords: clinical practice; inward admission; quality of care; triple therapy