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French study shows that ICU admissions for and mortality from severe COPD exacerbations are increasing despite improved management methods.
The incidence of severe chronic obstruction pulmonary disorder (COPD) exacerbations has increased in recent years in France, according to the results of a study published in Respiratory Research. Additionally, the number of patients admitted to the intensive care unit (ICU) for these exacerbations has also increased.
“COPD admissions are increasing in incidence and direct expenses and, despite modifications of management, mortality is also increasing,” study researcher Arnaud Bourdin, MD, of the University of Montpellier, France, told Medical Economics.
Bourdin and colleagues conducted this observational study to look at trends in mortality, costs and in-hospital management and outcomes for patients with severe COPD exacerbations admitted to the hospital in France. According to Bourdin, studying the incidence of COPD exacerbations is important because they are a marker of the burden of the disease over time.
The researchers obtained data for the study from the French admissions registry, looking at six consecutive years of severe COPD exacerbations leading to hospitalizations. Data were collected from 2007 to 2012. The researchers defined hospitalization as a stay of at least one night in a hospital, and included only those patients with the International Classification of Disease-10 code for COPD as a primary diagnosis. Patients were split into four groups; those with hospitalization in a general ward without acute respiratory failure, general ward with acute respiratory failure, ICU without invasive mechanical ventilation and ICU with mechanical ventilation.
Between 2007 and 2012, there was a 15.48% increase in admissions for severe COPD exacerbations from 113,276 in 2007 to 133,497 in 2012. This increase included almost a 50% increase in the number of ICU admissions. Admissions by age (+9.9 months) and gender (-2.5% of male), and length of stay (-0.29 day) changed only slightly during the study period.
“The increasing incidence of COPD admissions observed here is different from what was reported in Spain and more generally in the Westernized countries in studies that used a very similar methodology,” the researchers wrote in the study. “The definition of COPD may vary throughout these countries as a potential explanation. A different level of severity restricted to France is another option; for instance the history of coal-mining as shown by our regional findings may contribute to these differences.”
Bourdin and colleagues found that the rates of in-hospital mortality increased significantly between 2007 and 2012 (+8.06%; P<.001); these increases followed seasonal variations, peaking in the winter. They also noted that pneumonia-related mortality increased by 37.2% during the study period. The researchers called this increase “surprising” given the improvement in the management of COPD in recent years.
In addition, to incidence and mortality, the total cost of hospitalization also increased by 12.6% from 602 million euros ($641 million) in 2007 to 678 million euros (~$722 million) in 2012. The highest cost noted for a single hospital stay was 337,000 euros ($359,000).
The study also tracked several changes in management of patients with COPD. For example, the use of chest X-ray declined by 41.3% and the use of computed tomography scan increased by 31.7%. In addition, 13.7% fewer spirometries and 22.6% fewer bronoscopies were performed.
“Incidence, costs and mortality are increasing over time despite important efforts of management, and more interestingly, the way patients are managed is changing–but it seems not in a good sense since mortality is increasing; these changes couldn't be linked to aging only,” Bourdin said.