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.

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.

[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.

Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study / Eficacia y seguridad de los antibióticos inhalados en pacientes con enfermedad pulmonar obstructiva crónica. Estudio observacional multicéntrico

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.

Antecedentes Nuestro objetivo fue describir la efectividad y seguridad de los antibióticos inhalados en enfermedad pulmonar obstructiva crónica (EPOC), así como el perfil de pacientes en los que se prescriben habitualmente y los grupos de pacientes que más pueden beneficiarse de este tratamiento. Métodos Estudio de cohorte observacional retrospectivo multicéntrico en pacientes con EPOC que habían recibido ≥1 dosis de antibióticos inhalados en los últimos 5 años. Se compararon los datos clínicos de los 2 años anteriores y posteriores al inicio del tratamiento. Criterio primario: exacerbaciones de EPOC. Criterios secundarios: efectos secundarios, sintomatología (purulencia del esputo, disnea), perfil microbiológico y erradicación de patógenos. Resultados De los 693 pacientes con EPOC analizados (74,1 años; 86,3% hombres; FEV1 medio=43,7%) el 71,7% presentaba bronquiectasias y el 46,6% presentaba infección bronquial crónica (IBC) por Pseudomonas aeruginosa (PA). Después de un año de tratamiento con antibióticos inhalados se produjo una disminución significativa en el número de exacerbaciones (−33,3%; p<0,001), ingresos hospitalarios (−33,3%; p<0,001) y días de hospitalización (−26,2%; p=0,003). No encontramos diferencias en la efectividad entre los pacientes con o sin bronquiectasias asociadas. Los resultados positivos fueron más pronunciados en los pacientes que erradicaron la PA. Encontramos una reducción significativa de la expectoración diaria (−33,1%; p=0,024), el esputo mucopurulento/purulento (−53,9%; p<0,001), el aislamiento de cualquier microorganismo potencialmente patógeno (MPP) (−16,7%; p<0,001), IBC por cualquier MPP (−37,4%; p<0,001) e ICB por PA (−49,8%; p<0,001). La IBC por cualquier MPP y más de 3 exacerbaciones previas se asociaron con una mejor respuesta al tratamiento. El 25,4% de los pacientes presentó efectos secundarios no graves, siendo los más frecuentes el broncoespasmo (10,5%), la disnea (8,8%) y la tos (1,7%). Conclusiones En los pacientes con EPOC con múltiples exacerbaciones o IBC por cualquier MPP (especialmente PA), los antibióticos inhalados parecen ser un tratamiento eficaz y seguro, independientemente de la presencia de bronquiectasias.

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

Introducción: el envejecimiento y el cambio sociocultural frente a la muerte hacen que cada vez sea mayor el número de personas que fallecen en los hospitales. Objetivos: analizar aspectos relacionados con la última semana de vida de los pacientes que fallecen en un hospital de agudos. Material y métodos: se evaluó a los pacientes mayores de 18 años que fallecieron en el hospital durante un año, excluyendo los fallecidos en cuidados intensivos y en urgencias. Se analizaron: datos demográficos, enfermedad principal, motivo de ingreso, enfermedad terminal, comorbilidad, medicación, inicio de sedación, instrumentaciones, incidencias y órdenes de no iniciar reanimación cardiopulmonar. Resultados: se evaluó a 401 pacientes, con una edad media ± desviación estándar de 78 ± 11 años y elevada comorbilidad. Eran terminales 348 (87%) pacientes y en 207 (52%) pacientes el motivo de ingreso estaba relacionado con su enfermedad principal. La sedación terminal fue necesaria en 311 (78%) pacientes y constaba en la historia clínica que se había consensuado con sus familiares en 294 (73%) pacientes. Para el control de síntomas, 214 (55%) pacientes requirieron la intervención del médico de guardia. En 145 (36%) pacientes se mantuvo la medicación activa además de la sedativa, y en 109 (40%) pacientes se realizaron exploraciones complementarias sin que éstas modificaran el pronóstico. Conclusiones: es preciso establecer objetivos terapéuticos razonables en relación con la situación del paciente y protocolizar las intervenciones para mejorar la calidad de vida al final de la vida

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 (AU)