Abstract

Introduction: Acute exacerbation of COPD (AECOPD) is a major event leading to hospitalizations and mortality. Visiting a respiratory specialist (RS) before or early in the course of AECOPD might lead to prompt treatment and better outcomes.

Aims and Objectives: To evaluate the associations between pre-admission RS visit and the characteristics of AECOPD.

Methods: A prospective cohort study in 13 medical centers across Israel, including patients hospitalized with AECOPD in internal medicine departments between 2017 and 2019. Patients were interviewed by a physician during admission.We analyzed 30-day RS visits, pre-admission care, and hospital outcomes.

Results: 344 patients were included during their AECOPD hospitalization. 105 (31%) visited a RS in the 30-days prior to admission due to respiratory symptoms. A RS visit was associated with early pre-hospital initiation of short acting bronchodilators (OR 2.1, 95% CI 1.3-3.3), systemic steroids (OR 3.1, 95% CI 1.8-5.2), and antibiotics (OR 2.6, 95% CI 1.5-4.4). Patients with a RS visit had higher rates of prior exacerbations (94% vs. 71%, p<0.001), Modified-Medical-Research-Council Dyspnea score above 1 (86% vs. 65%, p<0.001), and long-term oxygen use (52% vs. 35%, p<0.01). Still, their combined rate of in-hospital mortality, intubation, and ICU transfer was similar to those without a RS visit (9% vs. 7%, p=0.45). Seeing a RS was also associated with a longer duration form first symptoms to admission (mean 6.1 vs. 3.8 days, p<0.001), signifying the possibility of reduced hospitalizations.

Conclusions: Prior RS visit may lead to early initiation of AECOPD treatment and postpone or reduce related hospitalizations.