Annals of the American Thoracic Society 2017 04 13() doi 10.1513/AnnalsATS.201611-903OC
Dry powdered inhalers (DPIs) are prescribed after hospitalization for acute exacerbation of COPD (AECOPD). Peak inspiratory flow (PIF) affects DPI delivery.
To study the impact of PIF on readmission after hospitalization for AECOPD.
A retrospective analysis of hospitalized patients, enrolled in an AECOPD care plan, was performed. Data analyzed included PIF, age, gender, length of stay, Charlson Comorbidity Index, COPD Assessment Test (CAT) and Modified Medical Research Council score, % predicted FEV1, FVC and inspiratory capacity (IC). A PIF equal to and less than 60 L/min was defined as suboptimal (sPIF). Outcome measures included 30 and 90 day COPD and all cause readmissions, and days to next COPD and all cause readmissions.
52% of the 123 subjects (n=64) had sPIF. They had greater CAT scores (29.1 +/- 5.9 vs 25.3 +/- 8.7, p=0.0073), rates of 90 day COPD readmissions (28.1% versus 13.6%, p=0.048), fewer median days to COPD (63.5, [IQR 21-89.8] versus 144 [66-218], p=0.002) and all cause readmissions (65.5 [IQR 24.3-107.3] versus 101 [54.5, 205.5], p=0.009). PIF was the only variable (p=0.041) that predicted days to COPD readmission in a multivariate model incorporating age, gender, % predicted FEV1, Charlson Comorbidity Index and inspiratory flow group. In a subset of patients with sPIF (n=22), all cause and COPD 30 and 90 day readmission rates were significantly lower for those discharged with nebulizer compared to DPI therapy.
sPIF is common during AECOPD and predicts COPD and all cause readmissions. Patients with sPIF may benefit from nebulized therapies. We recommend checking PIF in patients hospitalized for AECOPD as it is a risk for readmission that may be associated with delivery device selection.