Missed Opportunities in the Therapeutic Patterns of Chronic Obstructive Pulmonary Disease: A Real-World Italian Study on the Impact of Severe Exacerbation on Mortality and Hospital Re-admission.

BACKGROUND AND

objectivesPatients experiencing severe exacerbation (SE) of chronic obstructive pulmonary disease (COPD) face high re-hospitalization and mortality rates. Knowing their impact on health services is crucial for making decisions and improving the care pathway for these patients. To describe mortality, re-hospitalizations and therapeutic patterns of patients experiencing SE, this study used real-world Italian administrative data and examined pre- and post-SE treatment patterns.

methodsFrom an Italian administrative database (4.6 million inhabitants), patients with COPD in 2022 were identified, and those experiencing SE requiring hospitalization were described in terms of demographics, comorbidities, 12-month mortality and re-hospitalization rates, and therapeutic patterns during 12 months pre- and post-SE. Treatment patterns included dispensations of single-inhaler (SI, i.e., fixed-dose combination) triple therapy (TT), multiple-inhaler (MI, i.e., open combination) TT, dual therapy (DT; based on combinations between inhaled corticosteroid/long-acting beta-agonist/muscarinic antagonist), other respiratory treatment strategies, and no treatment.

resultsAmong 81,571 patients with COPD (32.1 per 1000 inhabitants aged ≥ 45 years), patients experiencing SE were 6.2% (5080 patients with COPD): mean age was 77 years, 63.4% (3220 patients with SE) were male and 68.2% (3467 patients with SE) had ≥ 3 comorbidities. Mean in-hospital length of stay was 11.9 days. One-year mortality rate was 25.6% (1302 patients with SE), mainly within the first month, 76.0% (989 deaths) of which occurred in hospital. Among 12-month analysable patients (3778), the 12-month re-hospitalization rate was 20.1% (761 patients with SE and alive) occurring, on average, at 155 days (16.4% within the first month). Pre/post SE, single-inhaler triple therapy (SI-TT) and multiple-inhaler triple therapy (MI-TT) increased from 1.4 to 23.4% and from 1.2 to 6.3% patients, respectively; DT, other strategies, and no treatment reduced from 24.5 to 22.5%, 35.7 to 23.8% and 37.1 to 24.0%, respectively. On average, TT was initiated at ≥ 31 days post-SE. Mean time to TT initiation was approximately 31-42 days depending on prior therapy, although most patients initiated TT within the first 30 days.

conclusionA substantial proportion of patients experiencing SE of COPD were re-hospitalised or remained inadequately treated or untreated, despite a high mortality rate. These findings underscore the necessity for a more appropriate and prompt therapeutic intervention.