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Ariel Melloul,1,2 Ophir Freund,1,2 Boaz Tiran,1,2 Tal Moshe Perluk,1,2 Netanel Golan,1,2 Eyal Kleinhendler,1,2 Evgeni Gershman,1,2 Avraham Unterman,1,2 Avishay Elis,2,3 Amir Bar-Shai1,2 1The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Internal Medicine C, Rabin Medical Center, Petach Tikva, IsraelCorrespondence: Ophir Freund, The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Tel +972-545-305648, Email ophir068@gmail.comPurpose: Exacerbations of COPD (ECOPD) significantly impact disease progression and mortality. Visiting a respiratory specialist (RS) in proximity to the exacerbation may lead to prompt treatment and improved outcomes. We aimed to evaluate the association between an RS visit 30-days before admission and exacerbation outcomes.Patients and methods: The prospective study included subjects that were hospitalized with ECOPD between 2017 and 2019 in 13 medical centers. Pre-admission, in-hospital, and 30-day outcomes were assessed and compared between patients with and without a 30-day RS visit, using propensity score matching. A sub-group analysis was performed based on the reason for the RS visit (emergent vs regular follow-up).Results: Three hundred and forty-four subjects were included, and 105 (31%) had pre-admission RS visit (RS group). Before matching, indicators of severe COPD were prevalent in the RS group, while after matching there were no differences. RS visits were associated with pre-hospital initiation of short acting bronchodilators (50% vs 36%), antibiotics (30% vs 17%), and systemic steroids (38% vs 22%). The RS group had longer duration between first symptoms to hospital arrival (median 5 vs 3 days, p < 0.01) and shorter hospital length-of-stay (median 4 vs 5 days, p = 0.04). In-hospital and 30-days outcomes were similar between the groups. However, a non-emergent pre-hospital RS visit was associated with improved in-hospital and 30-day outcomes.Conclusion: Routine RS visits could lead to correct and early treatment for ECOPD with a potential for improved outcomes. These findings highlight the need for available specialists and higher awareness.Keywords: clinic, pulmonologist, bronchodilators, admission, diagnosis |
