Moderate-High Blood Eosinophilia Is Associated with Increased Hospitalization and Other Asthma Comorbidities.

(1) Background: Eosinophilia has traditionally been linked to eosinophilic asthma, for which it is the gold-standard prognostic biomarker. However, the association between eosinophilia and the presence of other diseases and comorbidities is yet unclear. (2) Methods: For this retrospective study, we reviewed the electronic medical records of 49,909 subjects with blood eosinophilia to gather data on the presence of asthma, COPD, sleep apnea, tuberculosis, dyslipidemia, hypertension, and other cardiovascular diseases and severe CRSwNP among these subjects. Demographic features including age, sex, and smoking habits were collected, as well as the number of hospitalizations and emergency department visits. T-tests, ANOVA, Fisher test, and logistic regression models were used. (3) Results: For all age groups studied, eosinophilia was significantly more prevalent among asthmatic subjects than nonasthmatics, especially in patients also presenting CRSwNP, hypertension, and dyslipidemia. The likelihood of developing asthma, COPD, and CRSwNP, and hospitalization, was increased when BEC was above 600 eosinophils/µL. The association between asthma, CRSwNP, and BEC was corroborated by multiple logistic regressions models. (4) Conclusions: We demonstrated the association of having over 600 blood eosinophils/µL with a higher number of hospitalizations and comorbidities (CRSwNP and COPD), which proves that BEC is a highly useful parameter to consider in subjects who present blood eosinophilia.

Decrease in Readmissions after Hospitalisation for COPD Exacerbation through a Home Care Model.

Objective: To decrease readmissions at 30 and 90 days post-discharge from a hospital admission for chronic obstructive pulmonary disease exacerbation (COPDE) through the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU), increase patient survival at one year, and validate our readmission risk scale (RRS). Materials and methods: This was an observational study, with a prospective data collection and a retrospective data analysis. A total of 491 patients with a spirometry diagnosis of chronic obstructive pulmonary disease (COPD) requiring hospitalisation for an exacerbation were included in the study. Subjects recruited within the first year (204 cases) received conventional care (CC). In the following year a home care (HC) programme was implemented and of those recruited that year (287) 104 were included in the ACRCU, administered by a specialised nurse. Results: In the group of patients included in the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU) a lower number of readmissions was observed at 30 and 90 days after discharge (30.5% vs. 50%, p = 0.012 and 47.7% vs. 65.2%, p = 0.031, respectively) and a greater one-year survival (85.3% vs. 59.1%, p < 0.001). The validation of our RRS revealed that the tool's capacity to predict readmissions at both 30 and 90 days was not high (AUC = 0.69 and AUC = 0.66, respectively). Conclusions: The inclusion of exacerbator or fragile COPD patients in the ACRCU could achieve a decrease in readmissions and an increase in survival. The number of episodes of exacerbation within the 12 months prior to the hospital admission is the variable that best predicts the risk of readmission.

Objetivo: Disminuir los reingresos a los 30 y 90 días tras el alta por un ingreso hospitalario por exacerbación de enfermedad pulmonar obstructiva crónica (EPOC) a través del modelo de atención domiciliaria de la Unidad de Cuidados Crónicos Respiratorios Ambulatorios (UCCRA), aumentar la supervivencia al año y validar nuestra escala de riesgo de reingreso (ERR). Material y métodos: Estudio observacional con recogida prospectiva de datos. Se incluyó en el estudio a un total de 491 pacientes con diagnóstico espirométrico de enfermedad pulmonar obstructiva crónica que requirieron hospitalización por una agudización. Los sujetos reclutados dentro del primer año (204 casos) recibieron atención convencional (AC). Al año siguiente se implementó un programa de atención domiciliaria (AD) y de los pacientes reclutados ese año (287), 104 fueron incluidos en la UCCRA con seguimiento de una enfermera especializada. Resultados: En el grupo de pacientes incluidos en el modelo de atención domiciliaria de la UCCRA se observó un menor número de reingresos a los 30 y 90 días tras el alta (30,5% vs 50%, p = 0,012 y 47,7% vs. 65,2%, p = 0,031, respectivamente) y una mayor supervivencia al año (85,3% vs. 59,1%, p < 0,001). La validación de nuestra ERR reveló que la capacidad de la misma para predecir reingresos tanto a los 30 como a los 90 días no era alta (AUC = 0,69 y AUC = 0,66, respectivamente). Conclusiones: La inclusión de pacientes con EPOC agudizadores o frágiles en la UCCRA podría conseguir una disminución de los reingresos y una aumento de la supervivencia. El número de agudizaciones en los 12 meses previos al ingreso hospitalario es la variable que mejor predice el riesgo de reingreso.