Trend from 2001 to 2015 in the prevalence of bronchiectasis among patients hospitalized for asthma and effect of bronchiectasis on the in-hospital mortality.

OBJECTIVE: We aimed to analyze the prevalence of bronchiectasis among patients hospitalized with asthma and to assess the effect of suffering bronchiectasis on in-hospital mortality (IHM). METHODS: We used the Spanish National Hospital Discharge Database from 2000 to 2015 to evaluate all admissions for asthma exacerbation as the main diagnosis, dividing them according to the presence or absence of associated bronchiectasis. We assessed time trends in the prevalence, clinical characteristics, length of hospital stay, costs, and IHM. RESULTS: Of 342,644 admissions for asthma, 10,377 (3.02%) had bronchiectasis. The prevalence of bronchiectasis increased from 2.16% in 2001 to 4.47% in 2015 (p < 0.001). Compared to patients without bronchiectasis, those with bronchiectasis were more frequently women (77.06% vs. 22.94%, p < 0.001), were older (68.87 ± 15.16 vs. 47.05 ± 30.66 years, p < 0.001) and had more comorbid conditions (Charlson comorbidity index ≥ 2: 9.45% vs. 6.58%, p < 0.001). Pseudomonas (8% vs. 0.66%, p < 0.001), Aspergillus (0.93% vs. 0.15%, p < 0.001), eosinophilia (0.29% vs. 0.17%, p = 0.005) and IHM (2.07% vs. 1.2%, p < 0.001) were more frequent in patients with bronchiectasis. After multivariable adjustments, IHM was not associated with bronchiectasis. The presence of bronchiectasis was associated with a longer length of hospital stay and higher costs. CONCLUSIONS: Admissions for asthma with bronchiectasis have increased over time in Spain. In our investigation, the presence of bronchiectasis was not associated with higher IHM, but it increased the length of hospital stay and costs.

[All Roads Lead to Rome: Results of Non-Invasive Respiratory Therapies Applied in a Tertiary-Care Hospital Without an Intermediate Care Unit During the COVID-19 Pandemic]. / Todos los caminos llevan a Roma: resultados de las terapias respiratorias no invasivas aplicadas en un centro terciario sin Unidad de Cuidados Intermedios durante la pandemia de COVID-19.

Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.

Hospitalizations for Community-Acquired and Non-Ventilator-Associated Hospital-Acquired Pneumonia in Spain: Influence of the Presence of Bronchiectasis. A Retrospective Database Study.

To examine and compare in-hospital mortality (IHM) of community-acquired pneumonia (CAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without bronchiectasis (BQ) using propensity score matching. A retrospective observational epidemiological study using the Spanish Hospital Discharge Records, 2016-17. We identified 257,455 admissions with CAP (3.97% with BQ) and 17,069 with NV-HAP (2.07% with BQ). Patients with CAP and BQ had less comorbidity, lower IHM, and a longer mean length of hospital stay (p < 0.001) than non-BQ patients. They had a higher number of isolated microorganisms, including Pseudomonas aeruginosa. In patients with BQ and NV-HAP, no differences were observed with respect to comorbidity, in-hospital mortality (IHM), or mean length of stay. P. aeruginosa was more frequent (p = 0.028). IHM for CAP and NV-HAP with BQ was 7.89% and 20.06%, respectively. The factors associated with IHM in CAP with BQ were age, comorbidity, pressure ulcers, surgery, dialysis, and invasive ventilation, whereas in NV-HAP with BQ, the determinants were age, metastatic cancer, need for dialysis, and invasive ventilation. Patients with CAP and BQ have less comorbidity, lower IHM and a longer mean length of hospital stay than non-BQ patients. However, they had a higher number of isolated microorganisms, including Pseudomonas aeruginosa. In patients with BQ and NV-HAP, no differences were observed with respect to comorbidity, in-hospital mortality, or mean length of stay, but they had a greater frequency of infection by P. aeruginosa than non-BQ patients. Predictors of IHM for both types of pneumonia among BQ patients included dialysis and invasive ventilation.

Characteristics and outcomes of patients hospitalized with interstitial lung diseases in Spain, 2014 to 2015.

To assess characteristics and outcomes of patients hospitalized with interstitial lung diseases (ILD) and to analyze patient's comorbidities, procedures, and in-hospital outcomes.We identified patients hospitalized with idiopathic pulmonary fibrosis and others ILD such as hypersensitivity pneumonitis, cryptogenic organizing pneumonia, lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, and sarcoidosis in Spain during 2014 and 2015.We identified 14,565 discharges among patients admitted for ILD in Spain during the study period: idiopathic pulmonary fibrosis (IPF) in 42.32% (n = 6164), sarcoidosis in 37.65% (n = 5484), hypersensitivity pneumonitis in 10.55% (n = 1538), cryptogenic organizing pneumonia in 7.06% (n = 1028), pulmonary Langerhans cell histiocytosis in 1.48% (n = 215), and lymphangioleiomyomatosis in 0.94% (n = 136). The most common associated comorbidities according to those included in the Charlson Comorbidity Index (CCI) were COPD, diabetes, and congestive heart disease. The presence of pulmonary hypertension increased the probability of dying in patients with idiopathic pulmonary fibrosis (OR 1.36; 95%CI 1.06-1.73). Patients with cryptogenic organizing pneumonia had the longest length of hospital stay and the highest percentage of hospital readmissions (23.64%). The highest IHM corresponded to the idiopathic pulmonary fibrosis (14.94%). Computed tomography of the chest was the procedure more used during admissions for ILD.IPF was responsible for larger percentage of hospital admission among ILD in our study. In addition, the IHM were higher in IPF patients in comparison with those with other ILD. The most common associated comorbidity in ILD according to those included in the CCI was COPD. Computed tomography of the chest was the procedure more frequently used.

Bronchiectasis in patients hospitalized with acute exacerbation of COPD in Spain: Influence on mortality, hospital stay, and hospital costs (2006-2014) according to gender.

PURPOSE: The objectives of this study were to analyze the characteristics of male and female patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) during 2006-2014 according to the presence or absence of bronchiectasis and to study the factors associated with in-hospital mortality (IHM) in patients hospitalized with AE-COPD and concomitant bronchiectasis. METHODS: We used the Spanish National Hospital Database to analyze patients admitted with AE-COPD as their primary diagnosis. Patients included in the study were stratified according to the presence or absence of bronchiectasis as their secondary diagnosis. RESULTS: We identified 386,646 admissions for AE-COPD, of which 19,679 (5.09%) involved patients with concomitant bronchiectasis. When patients with and without bronchiectasis were compared, we observed that the incidence of infection by Pseudomonas aeruginosa was substantially higher in the former, as were the mean stay, cost, and percentage of readmissions, although IHM and comorbidity were lower. The course of patients with AE-COPD and bronchiectasis was characterized by a gradual increase in prevalence and mean age among men and no differences in prevalence or lower mean age in women. Mortality was 4.24% and 5.02% in patients with and without bronchiectasis, respectively, although significance was lost after a multivariate adjustment (OR 0.94; 95% CI, 0.88-1.01). The factors associated with IHM were older age, higher comorbidity, isolation of P. aeruginosa, mechanical ventilation and readmission. CONCLUSIONS: The prevalence of admission with AE-COPD and bronchiectasis increased in men but not in women during the study period. In patients hospitalized with AE-COPD, we did not find differences in mortality when comparing the presence and absence of bronchiectasis. The analysis of temporal trends revealed a significant reduction in mortality from 2006 to 2014 in male patients with COPD and concomitant bronchiectasis, but not among women. It is important to consider the factors associated with IHM such as age, comorbidity, isolation of P. aeruginosa, mechanical ventilation and readmission to better identify those patients who are at greater risk of dying during hospitalization.

Comorbidities and risk of mortality among hospitalized patients with idiopathic pulmonary fibrosis in Spain from 2002 to 2014.

BACKGROUND: To describe and compare the comorbid conditions, the in-hospital mortality (IHM) and the length of hospital stay (LOHS) among idiopathic pulmonary fibrosis (IPF) patients and non-IPF-matched patients hospitalized in Spain. We assess the performance of the Charlson Comorbidity Index[CCI] and the Elixhauser Comorbidity Index[ECI] to predict IHM in IPF and we identify the specific predictive factors of IHM in patients suffering IPF. METHODS: We identified patients with IPF hospitalized in years 2002, 2006, 2010 and 2014. Cases of IPF were matched with non-IPF controls by sex, age, province of residence and year. Data were collected from the Spanish National Hospital Discharge Database. RESULTS: We identified 10,285 hospitalizations with IPF, evidencing an increase in the number of IPF patients from 2002 to 2014. Overtime the prevalence of comorbidities included in the CCI significantly increased in patients with IPF, exception made of myocardial infarction and dementia. The prevalence of comorbidities included in the ECI, except paralysis and peptic ulcer disease excluding bleeding, increased significantly overtime. LOHS was longer among IPF patients than non-IPF controls and decreased significantly from 2002 to 2014. IHM was significantly higher in patients with IPF (adjustedOR 1.97; 95%CI 1.77-2.19). Area under the ROC curves showed that ECI model had a better performance to predict IHM than CCI. CONCLUSIONS: The incidence of hospitalizations for IPF increased significantly from 2002 to 2014. We observed an increase overtime of most of the comorbidities included in CCI and ECI. LOHS and IHM were higher in patients with IPF than in non-IPF controls.

Retrospective observational study of trends in hospital admissions for idiopathic pulmonary fibrosis in Spain (2004-2013) using administrative data.

OBJECTIVE: To assess changes in incidence, diagnostic procedures, comorbidity profiles, length of hospital stay (LOHS), economic costs and in-hospital mortality (IHM) associated with idiopathic pulmonary fibrosis (IPF). METHODS: We identified patients hospitalised with IPF in Spain from 2004 to 2013. Data were collected from the National Hospital Discharge Database. RESULTS: The study population comprised 22 214 patients. Overall crude incidence increased from 3.82 to 6.98 admissions per 100 000 inhabitants from 2004 to 2013 (p<0.05). The percentage of lung biopsies decreased significantly from 10.68% in 2004 to 9.04% in 2013 (p<0.05). The percentage of patients with a Charlson comorbidity index ≥2 was 15.14% in 2004, increasing to 26.95% in 2013 (p<0.05). IHM decreased from 14.77% in 2004 to 13.72% in 2013 (adjusted OR 0.98; 95% CI 0.97 to 0.99). Mean LOHS was 11.87±11.18 days in 2004, decreasing to 10.20±11.12 days in 2013 (p<0.05). The mean cost per patient increased from €4838.51 in 2004 to €5410.90 in 2013 (p<0.05). CONCLUSIONS: The frequency of hospital admissions for IPF increased during the study period, as did healthcare costs. However, IHM and LOHS decreased.

Time Trends in Hospital Admissions for Bronchiectasis: Analysis of the Spanish National Hospital Discharge Data (2004 to 2013).

OBJECTIVE: To analyze changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) for patients with bronchiectasis who were hospitalized in Spain over a 10-year period. METHODS: We included all admissions for patients diagnosed with bronchiectasis as primary or secondary diagnosis during 2004-2013. RESULTS: 282,207 patients were admitted to the study. After controlling for possible confounders, we observed a significant increase in the incidence of hospitalizations over the study period when bronchiectasis was a secondary diagnosis. When bronchiectasis was the primary diagnosis we observed a significant decline in the incidence. In all cases, this pathology was more frequent in males, and the average age and comorbidity increased significantly during the study period (p<0.001). When bronchiectasis was the primary diagnosis, the most frequent secondary diagnosis was Pseudomonas aeruginosa infection. When bronchiectasis was the secondary diagnosis, the most frequent primary diagnosis was COPD. IHM was low, tending to decrease from 2004 to 2013 (p<0.05). The average LOHS decreased significantly during the study period in both cases (p<0.001). The mean cost per patient decreased in patients with bronchiectasis as primary diagnosis, but it increased for cases of bronchiectasis as secondary diagnosis (p<0.001). CONCLUSIONS: Our results reveal an increase in the incidence of hospital admissions for patients with bronchiectasis as a secondary diagnosis from 2004 to 2013, as opposed to cases of bronchiectasis as the primary diagnosis. Although the average age and comorbidity significantly increased over time, both IHM and average LOHS significantly decreased.

EPOC y alteraciones endocrinometabólicas / COPD and endocrine and metabolic alterations

La evolución clínica y el manejo terapéutico de la enfermedad pulmonar obstructiva crónica (EPOC) puedenverse afectados por la presencia de alguna comorbilidad, lo que además suele contribuir a empeorar elpronóstico. Entre las alteraciones endocrinometabólicas que pueden asociarse a la EPOC, se encuentran ladiabetes mellitus, la osteoporosis, el síndrome metabólico o la malnutrición. Son diversos los posibles mecanismosetiopatogénicos que intervienen en la asociación entre EPOC y diferentes trastornos endocrinometabólicos,como el tabaco y la respuesta infl amatoria sistémica con intervención de diferentes citocinas,entre otros. Por otro lado, los glucocorticoides sistémicos a dosis altas utilizados en el tratamiento de laEPOC grave y de las agudizaciones, supone un factor importante en el riesgo de desarrollar ciertas alteracionesmetabólicas, como la diabetes mellitus y la osteoporosis.En el estudio del paciente con EPOC, es importante identifi car los posibles trastornos endocrinometabólicoscoexistentes, para aplicar medidas de corrección y de prevención. Por lo general, los pacientes se beneficiarán de la inclusión en un programa de rehabilitación respiratoria con ejercicio físico y una dieta equilibrada,además del tratamiento farmacológico oportuno en cada caso. También resultan fundamentalesciertas medidas, como evitar el tabaquismo, el sedentarismo, y realizar el tratamiento correcto de la EPOC(AU)

The clinical course and therapeutic management of chronic obstructive pulmonary disease (COPD) may beaffected by the presence of comorbid diseases, which also usually worsen prognosis. Among theendocrinological and metabolic alterations that can be associated with COPD are diabetes mellitus,osteoporosis, metabolic syndrome and malnutrition. There are several possible etiopathogenic mechanismsthat intervene in the association between COPD and distinct endocrine and metabolic disorders, such assmoking and systemic infl ammation, infl uenced by distinct cytokines among other factors. The high-doseglucocorticosteroids used in the treatment of severe COPD and exacerbations are a major risk factor for thedevelopment of some metabolic alterations such as diabetes and osteoporosis.Study of patients with COPD should identify the possible coexisting endocrinological and metabolicalterations in order to apply preventive measures and treatment. In general, patients benefi t from beingincluded in a respiratory rehabilitation program with physical exercise and a balanced diet, in addition toappropriate drug treatment in each case. Certain measures such as avoiding smoking and sedentariness arealso essential in the correct treatment of COPD(AU)