Obstructive Lung Diseases |

Hospital Admission for COPD Exacerbation: An Opportunity for Azithromycin? FREE TO VIEW

Nidhi Patel; Stephanie Taylor; Shan Cheng; Allen Brown; David DiNuoscio; Brice Taylor
Chest. 2015;148(4_MeetingAbstracts):685A. doi:10.1378/chest.2277787
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Hospitalization for COPD exacerbation is most common among patients with the “frequent exacerbator” phenotype. Hospital admission for COPD exacerbation is frequent in the U.S., with 606,000 admissions in 2010 and 21% of these patients will experience readmission within 30-days. Although preventing hospitalization is a key goal for patients and healthcare systems, the hospital admission represents an opportunity to optimize care. Good evidence supports the effectiveness of daily azithromycin therapy for reducing COPD exacerbations, yet this therapy remains underutilized amid concerns for cardiac toxicity. We sought to evaluate the potential impact of an intervention designed to promote the use of chronic azithromycin in appropriate patients during hospitalization for COPD exacerbation.

METHODS: We reviewed medical records from 253 patients admitted to Tampa General Hospital in Tampa, FL with a primary diagnosis of COPD exacerbation. We extracted data to evaluate how many patients were receiving chronic azithromycin and to determine if the patients met any contraindications for azithromycin therapy. We also recorded smoking status and the number of hospital readmissions within the following year.

RESULTS: 2 patients (0.008%) were excluded because they were already receiving chronic azithromycin. Of 251 remaining patients, 39% were female, and the average age was 62.3 years. 49.8% were current smokers. 52.6% of patients were readmitted to the same hospital within 1 year, and almost 10% had > 5 readmissions. Only 23.9% of the patients had no contraindication to azithromycin therapy. With regard to specific contraindications, 10% had QTc prolongation, 53% were taking concurrent QT prolonging medications, 33.5% had underlying coronary artery disease or cardiomyopathy and 13.2% had a resting heart rate > 100 beats per minute.

CONCLUSIONS: Consistent with other reports, we found the use of chronic azithromycin therapy to be very uncommon among patients hospitalized for COPD exacerbation. Over three-quarters of the patients in our sample were not appropriate candidates for azithromycin therapy due to risk factors for cardiovascular toxicity.

CLINICAL IMPLICATIONS: Patients hospitalized for COPD exacerbation are likely to be “frequent exacerbators”, and could potentially benefit from chronic azithromycin. However, an intervention designed to promote azithromycin initiation may be low-yield, because the majority of hospitalized patients in our sample had a contraindication predisposing them to cardiac toxicity.

DISCLOSURE: The following authors have nothing to disclose: Nidhi Patel, Stephanie Taylor, Shan Cheng, Allen Brown, David DiNuoscio, Brice Taylor

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