Factors associated with short-term recovery of health status among emergency department patients with acute exacerbations of chronic obstructive pulmonary disease
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To determine the factors associated with short-term recovery of health status following chronic obstructive pulmonary disease (COPD) exacerbation.
In a prospective multicenter cohort study, consecutive emergency department (ED) patients with COPD exacerbation were enrolled. Patients were interviewed and instructed to complete the validated Short Form Chronic Respiratory disease Questionnaire. Follow-up data were collected 2 weeks later, and included the global transition question. The primary outcome was recovery of health status, which was assigned to patients who stated that their COPD was “a little better” or “much better” than at the time of their ED presentation.
Of the 330 patients, 270 [82%; 95% confidence interval (CI), 77–86%] reported recovery of health status following acute exacerbations. Multivariable analysis showed that recovery of health status was associated with having a primary care provider (PCP) [odds ratio (OR), 3.1; 95% CI, 1.5–6.4] and a co-diagnosis of asthma (OR, 2.2; 95% CI, 1.2–3.8). By contrast, frequent exacerbations (two or more exacerbations in the past year) (OR, 0.4; 95% CI, 0.2–0.7) was inversely associated with recovery.
Reducing exacerbation frequency and provision of adequate PCP follow-up after ED visit may help improve the recovery of health status following acute exacerbations of COPD.
KeywordsChronic obstructive pulmonary disease Emergency department Exacerbation Health status Recovery
The authors thank the EMNet investigators for their ongoing dedication to public health research, with an emphasis on the treatment and prevention of respiratory/allergy emergencies.
EMNet Steering Committee: Adit A. Ginde, MD, MPH; Edwin D. Boudreaux, PhD; Carlos A. Camargo, Jr., MD, DrPH (Chair); Jonathan M. Mansbach, MD; Steven Polevoi, MD; Michael S. Radeos, MD, MPH; and Ashley F. Sullivan, MS, MPH.
EMNet Coordinating Center: Angela Anderson; Carlos A. Camargo, Jr., MD (Director); Kate Delaney; Lisa A. Dubois; Janice Espinola, MPH; Jessica Pang; Ashley F. Sullivan, MS, MPH; and Chu-Lin Tsai, MD, MPH—all at Massachusetts General Hospital, Boston.
Principal Investigators at the 29 Participating Sites: F.C. Baker III (Maine Medical Center, Portland, ME); M.P. Blanda (Summa Health System, Akron, OH); E.D. Boudreaux (Earl K. Long Memorial Hospital, Baton Rouge, LA); B.E. Brenner (The Brooklyn Hospital Center, Brooklyn, NY); C.A. Camargo Jr. (Massachusetts General Hospital, Boston, MA); R.K. Cydulka (MetroHealth Medical Center, Cleveland, OH); T.J. Gaeta (New York Methodist Hospital, Brooklyn, NY); B. Goldfeder (Shands Hospital at the University of Florida, Gainesville, FL); R.J. Grant (Hartford Hospital, Hartford, CT); R.O. Gray (Hennepin County Medical Center, Minneapolis, MN); A. Guttman (Sir Mortimer B. Davis–Jewish General Hospital, Montreal, QC); L.W. Kreplick (Christ Hospital & Medical Center, Oak Lawn, IL); D.S. Mackey (Lethbridge Regional Hospital, Lethbridge, AB); A. Mangione (Albert Einstein Medical Center, Philadelphia, PA); J. Peters (University of Texas Health Sciences Center at San Antonio, San Antonio, TX); M.S. Radeos (Lincoln Medical Center, Bronx, NY); P.L. Rice (Brigham and Women’s Hospital, Boston, MA); B.H. Rowe (University of Alberta Hospital, Edmonton, AB); M. Sama (St. Joseph Mercy Hospital, Ann Arbor, MI); D. Schreiber (Stanford University Medical Center, Stanford, CA); N.I. Shapiro (Beth Israel Deaconess Medical Center, Boston, MA); P.C. Shukla (University of Texas Southwestern Medical Center, Dallas, TX); D. Sinclair (Queen Elizabeth II Health Science Centre (Halifax, NS); H. Smithline (Baystate Medical Center, Springfield, MA); P.E. Sokolove (UC Davis Medical Center, Sacramento, CA); M. Steffens (Palmetto Richland Memorial Hospital, Columbia, SC); C.A. Terregino (Cooper Hospital/University Medical Center, Camden, NJ); A. Travers (Royal Alexandria Hospital, Edmonton, AB); and E.J. Weber (UCSF Medical Center, San Francisco, CA).
Funding: The cohort studies were supported by an unrestricted grant from Boehringer Ingelheim (Ridgefield, CT, USA and Burlington, Ontario, Canada).
- 4.Seemungal, T. A., Donaldson, G. C., Paul, E. A., Bestall, J. C., Jeffries, D. J., & Wedzicha, J. A. (1998). Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 157(5 Pt 1), 1418–1422.PubMedGoogle Scholar
- 8.Tsai, C. L., Hodder, R. V., Page, J. H., Cydulka, R. K., Rowe, B. H., & Camargo, C. A., Jr. (2008). The short-form chronic respiratory disease questionnaire was a valid, reliable, and responsive quality-of-life instrument in acute exacerbations of chronic obstructive pulmonary disease. Journal of Clinical Epidemiology, 61(5), 489–497. doi: 10.1016/j.jclinepi.2007.07.003.CrossRefPubMedGoogle Scholar
- 12.Cydulka, R. K., Rowe, B. H., Clark, S., Emerman, C. L., & Camargo, C. A., Jr. (2003). Emergency department management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: The Multicenter Airway Research Collaboration. Journal of the American Geriatrics Society, 51(7), 908–916. doi: 10.1046/j.1365-2389.2003.51302.x.CrossRefPubMedGoogle Scholar
- 14.Rabe, K. F., Hurd, S., Anzueto, A., et al. (2007). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American Journal of Respiratory and Critical Care Medicine, 176(6), 532–555. doi: 10.1164/rccm.200703-456SO.CrossRefPubMedGoogle Scholar
- 15.Radeos, M. S., Cydulka, R. K., Rowe, B. H., Barr, R. G., Clark, S., & Camargo, C. A., Jr. (2008). Validation of self-reported chronic obstructive pulmonary disease among patients in the ED. The American Journal of Emergency Medicine (in press).Google Scholar
- 16.Federal census data: Statistics Canada. Ottawa, ON, Canada: Health Canada (1996).Google Scholar
- 17.CACI. (2002). The sourcebook of ZIP code demographics. Fairfax, Virginia: CACI.Google Scholar
- 25.Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: Wiley (Wiley series in probability and statistics).Google Scholar
- 26.Long, J. S., & Freese, J. (2006). Regression models for categorical dependent variables using Stata (2nd ed.). College Station, Tex: StataCorp LP.Google Scholar
- 27.Tsai, C. L., Griswold, S. K., Clark, S., & Camargo, C. A., Jr. (2007). Factors associated with frequency of emergency department visits for chronic obstructive pulmonary disease exacerbation. Journal of General Internal Medicine, 22(6), 799–804. doi: 10.1007/s11606-007-0191-7.CrossRefPubMedGoogle Scholar
- 29.Sin, D. D., Bell, N. R., Svenson, L. W., & Man, S. F. (2002). The impact of follow-up physician visits on emergency readmissions for patients with asthma and chronic obstructive pulmonary disease: A population-based study. The American Journal of Medicine, 112(2), 120–125. doi: 10.1016/S0002-9343(01)01079-8.CrossRefPubMedGoogle Scholar
- 30.Sin, D. D., Bell, N. R., & Man, S. F. (2004). Effects of increased primary care access on process of care and health outcomes among patients with asthma who frequent emergency departments. The American Journal of Medicine, 117(7), 479–483. doi: 10.1016/j.amjmed.2004.04.011.CrossRefPubMedGoogle Scholar
- 34.Buchbinder, R., Bombardier, C., Yeung, M., & Tugwell, P. (1995). Which outcome measures should be used in rheumatoid arthritis clinical trials? Clinical and quality-of-life measures’ responsiveness to treatment in a randomized controlled trial. Arthritis and Rheumatism, 38(11), 1568–1580. doi: 10.1002/art.1780381108.CrossRefPubMedGoogle Scholar
- 39.Rothman, K. J., & Greenland, S. (1998). Epidemiology (2nd ed.). Philadelphia: Lippincott-Raven.Google Scholar