Comparisons of the Characteristics for Non-hospitalized, Hospitalized, and Rehospitalized Patients due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Ja Yun Choi; So Young Yun

doi:10.7475/kjan.2019.31.4.427

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Choi and Yun: Comparisons of the Characteristics for Non-hospitalized, Hospitalized, and Rehospitalized Patients due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Original Article

Korean Journal of Adult Nursing 2019; 31(4): 427-438.

Published online: 23 August 2019

DOI: https://doi.org/10.7475/kjan.2019.31.4.427

Comparisons of the Characteristics for Non-hospitalized, Hospitalized, and Rehospitalized Patients due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Ja Yun Choi¹

, So Young Yun²

¹Professor, College of Nursing, Chonnam National University, Gwangju, Korea.

²Assistant Professor, Department of Nursing, Nambu University, Gwangju, Korea.

Corresponding author: Yun, So Young. Department of Nursing, Nambu University, 23 Chumdan Jungang-ro, Gwangsan-gu, Gwangju 62271, Korea. Tel: +82-62-970-0391, Fax: +82-62-970-0399, yunsy@nambu.ac.kr

Received 16 May 2019 Revised 21 June 2019 Accepted 10 July 2019

Korean Society of Adult Nursing

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study compares the characteristics of patients with Chronic Obstructive Pulmonary Disease (COPD) according to hospitalization frequency due to Acute Exacerbation (AE) using a retrospective medical records review.

Methods

From August to October 2017, COPD patients who had visited the chonnam national university hospital were classified into three groups: (1) not hospitalization (n=115), (2) hospitalized once owing to AE (n=79) and (3) hospitalized twice or more owing to AE (n=47), and their medical records were reviewed. Data were analyzed using χ², Kruskal Wallis, and Mann-Whitney tests, and logistic regression.

Results

Home oxygen therapy, metered dose inhaler use, long-acting beta2-agonist, and Inhaled Corticosteroids (ICS) were used most in patients who were hospitalized twice or more. Symptoms of dyspnea and fever, prescription of phosphodiesterase-4 and oral corticosteroid were the least frequent in the patients who were not hospitalized, and they had the best pulmonary function test results. Home oxygen therapy (Odds Ratio [OR]=9.59, 95% Confidence Interval [CI]=2.53~36.46), and prescribed ICS (OR=2.77, 95% CI=1.14~6.77) and phosphodiesterase-4 (OR=5.35, 95% CI=1.69~16.93) were significantly associated with COPD readmission. For patients who were hospitalized once, SpO₂ (p=.016), the frequency of positive pressure ventilation therapy (p=.023) and monitoring of oxygen saturation in nursing activities (p=.022) were higher than that of patients who were hospitalized twice or more. There was no significant difference in discharge education between the two hospitalized groups.

Conclusion

Regardless of the severity of illness, presence of respiratory symptoms, drug prescribed, or admission frequency, there were no differences in nursing activities and discharge education.

Keywords: Pulmonary disease, chronic obstructive, Patient readmission, Medical records, Nursing, practical

Figures and Tables

Table 1

Comparison of General Characteristics among Three Groups (N=241)

BMI=body mass index; ^†Fisher's exact test.

Table 2

Comparison of Disease-related Characteristics among Three Groups (N=241)

FEV1 % pred=forced expiratory volume in 1 second % predictive; FEV1/FVC=ratio of forced expiratory volume in 1 second to forced vital capacity; GOLD=global initiative for chronic obstructive lung disease; ICS=inhalded corticosteroids; LABA=long-acting beta2-agonist; LAMA=long-acting muscarinic-antagonist; MDI=metered dose inhaler; PDE4 inhibitor=phosphodiesterase-4; ^†Fisher's exact test.

Table 3

Factors Influencing Hospitalization in Patients with Chronic Obstructive Pulmonary Disease

CI=confidence interval; GOLD=the global initiative for chronic obstructive lung disease; ICS=inhalded corticosteroids; LABA=long-acting beta2-agonist; MDI=metered dose inhaler; NA=not available; PDE4 inhibitor=phosphodiesterase-4; SE=standard error; ^†FEV1 % pred and FEV1/FVC was excluded.

Table 4

Comparisons of Hospitalization-related Characteristics between Two Hospitalized Groups (N=126)

ABGA=arterial blood gas analysis; CRP=C-reactive protein; DBP=diastolic blood pressure; ER=emergency room; ICU=intensive care unit; MDI=metered dose inhaler; PaCO₂=arterial carbon dioxide tension; SBP=systolic blood pressure; SpO₂=peripheral capillary oxygen saturation; ^†Fisher's exact test.

ACKNOWLEDGEMENT

This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (2016R 1D 1A3B03933227).

Notes

^{CONFLICTS OF INTEREST} The authors declared no conflict of interest.

^AUTHORSHIP

Study conception and design acquisition - CJY and YSY.
Data collection - YSY.
Analysis and interpretation of the data - CJY and YSY.
Drafting and critical revision of the manuscript - CJY.

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ORCID iDs

Ja Yun Choi
https://orcid.org/0000-0002-1284-250X

So Young Yun
https://orcid.org/0000-0003-2562-4592

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