10.25419/RCSI.13234481
Breda Cushen
Risk Factors for Repeat Healthcare Use following Hospitalisation with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease
<div>Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death</div><div>worldwide. Up to one-tenth of patients hospitalised with a COPD exacerbation die</div><div>during admission and, of those surviving to discharge, more than one-third will be</div><div>readmitted within 90 days with many more treated for a repeat exacerbation in the</div><div>emergency department or in the community. These figures are reported universally,</div><div>despite significant variation in the access to, structure and resources of healthcare</div><div>systems across different jurisdictions. However, even with the high frequency of</div><div>exacerbations, and the severity of their consequences, they remain poorly understood</div><div>and poorly studied. Furthermore, there is no robust clinical predictive tool to aid</div><div>physicians in their assessment of who is most at risk at the time of hospital discharge.</div><div>In this thesis, I explore the reasons why so many patients hospitalised with an</div><div>exacerbation of COPD experience a repeat exacerbation within 90-days of discharge.</div><div>By using change in respirable lung volume as a marker of treatment response, I</div><div>successfully test the hypothesis that the risk of repeat exacerbation in COPD is</div><div>increased in patients whose exacerbation has failed to adequately recover by the time</div><div>of hospital discharge. In addition, I discuss the derivation of a clinical score, the</div><div>COPD-2-HOME score, which incorporates treatment response, as determined by</div><div>change in lung volumes, symptoms, underlying disease severity, prior healthcare use</div><div>and the presence of stable state eosinophilia, to estimate the risk of 90-day</div><div>moderate-severe COPD exacerbation at the time of hospital discharge. I demonstrate</div><div>how the five point COPD-2-HOME score can reliably stratify patients into groups of</div><div>Low, Intermediate and High risk of re-exacerbation, through its external validation in</div><div>three multinational study cohorts. I also explore other potential reasons for the high</div><div>rates of healthcare use amongst COPD patients, which were not captured in the</div><div>derivation study, including variations in adherence to inhaled therapies, and examine</div><div>the relationship of distinct adherence behaviours to clinical outcomes in this cohort.</div><div>Finally, I discuss the implications of this work and propose a new strategy for the</div><div>future management of patients hospitalised with an acute exacerbation of COPD.</div>
110203 Respiratory Diseases
Royal College of Surgeons in Ireland
2020
2020-11-13
2020-11-13
Thesis
5967060 Bytes
CC BY-NC-SA 4.0