Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study.

BACKGROUND: We aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment. METHODS: Multicentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. PRIMARY OUTCOME: COPD exacerbations. SECONDARY OUTCOMES: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication. RESULTS: Of 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV1=43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (-33.3%; P<.001), hospital admissions (-33.3%; P<.001) and hospitalization days (-26.2%; P=.003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (-33.1%; P=.024), mucopurulent/purulent sputum (-53.9%; P<.001), isolation of any potentially pathogenic microorganisms (PPM) (-16.7%; P<.001), CBI by any PPM (-37.4%; P<.001) and CBI by PA (-49.8%; P<.001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%). CONCLUSIONS: In COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.

Cost of Hospitalizations due to Exacerbation in Patients with Non-Cystic Fibrosis Bronchiectasis.

BACKGROUND: Knowing the cost of hospitalizations for exacerbation in bronchiectasis patients is essential to perform cost-effectiveness studies of treatments that aim to reduce exacerbations in these patients. OBJECTIVES: To find out the mean cost of hospitalizations due to exacerbations in bronchiectasis patients, and to identify factors associated with higher costs. METHODS: Prospective, observational, multicenter study in adult bronchiectasis patients hospitalized due to exacerbation. All expenses from the patients' arrival at hospital to their discharge were calculated: diagnostic tests, treatments, transferals, home hospitalization, admission to convalescence centers, and hospitals' structural costs for each patient (each hospital's tariff for emergencies and 70% of the price of a bed for each day in a hospital ward). RESULTS: A total of 222 patients (52.7% men, mean age 71.8 years) admitted to 29 hospitals were included. Adding together all the expenses, the mean cost of the hospitalization was EUR 5,284.7, most of which correspond to the hospital ward (86.9%), and particularly to the hospitals' structural costs. The adjusted multivariate analysis showed that chronic bronchial infection by Pseudomonas aeruginosa, days spent in the hospital, and completing the treatment with home hospitalization were factors independently associated with a higher overall cost of the hospitalization. CONCLUSIONS: The mean cost of a hospitalization due to bronchiectasis exacerbation obtained from the individual data of each episode is higher than the cost per process calculated by the health authorities. The most determining factor of a higher cost is chronic bronchial infection due to P. aeruginosa, which leads to a longer hospital stay and the use of home hospitalization.

[The final week of life in an acute care hospital: review of 401 consecutive patients]. / Ultima semana de vida en un hospital de agudos: revisión de 401 pacientes consecutivos.

INTRODUCTION: because of population ageing and sociocultural changes related to death, increasing the numbers of patients are dying in hospitals. OBJECTIVES: to analyze patient characteristics and end-of-life care in the final week of life in patients dying in an acute-care hospital. MATERIAL AND METHODS: all patients older than 18 years old who died in the hospital over a 1-year period were analyzed. Patients dying in intensive care and emergency units were excluded. The following variables were evaluated: demographic data, main illness, cause of admission, comorbidity, terminal illness, medication, delay in beginning palliative sedation, use of devices, adverse events, and do not attempt resuscitation orders. RESULTS: a total of 401 patients (mean age: 78 +/- 11 years) with numerous comorbidities were evaluated. Of these, 348 patients (87%) were considered to be terminal. The reason for admission was related to the main disease in 207 patients (52%). Terminal sedation was applied in 311 patients (78%), and informed consent from the relatives was documented in 294 patients (73%). Intervention by on-call physician was required to control symptom aggravation in 214 patients (55%). Active medication was maintained in addition to sedation in 145 patients (36%). Complementary examinations were performed in 109 patients (40%), but did not modify prognosis. CONCLUSIONS: reasonable therapeutics objectives relating to the patient's situation and guidelines to improve quality of life at the end of life should be established.