Hospital readmission for patients with bronchiectasis and COPD is a major problem. In fact, one out of every eleven patients with COPD is readmitted to the hospital only 30 days after discharge. A recent report from the Division of Population Health at the Centers for Disease Control and Prevention (CDC), published in Chest Journal, indicates that although 21% of COPD and bronchiectasis patients are readmitted to the hospital within 30 days of discharge, 7% of patients are readmitted with COPD or bronchiectasis as the primary diagnosis and 18% with COPD or bronchiectasis as any diagnosis.
Individuals with severe cases of the disease or who are living in low socioeconomic areas tend to have higher rates of hospital readmission. The study “Socioeconomic Deprivation, Readmissions, Mortality, and Acute Exacerbations,” published in Internal Medicine Journal, revealed that 46% of patients considered to be among the 20% most deprived in New Zealand had at least one readmission following discharge from a diagnosis of bronchiectasis, and 21% died within a year of admission to the hospital. Those with an increased severity of disease were more likely to be readmitted, but there was no correlation between disease severity and mortality.
Another study, entitled “Hospital discharges, readmissions, and emergency department visits for chronic obstructive pulmonary disease or bronchiectasis among US adults” and published in Chest examined trends in hospital readmission rates from 2001 to 2012 among adults aged ≥18 years in the United States who had either bronchiectasis or COPD. Using data from the Nationwide Inpatient Sample and Nationwide Emergency Department Sample, the researchers examined temporal trends in the numbers and rates of hospitalizations by patients with COPD or bronchiectasis, including their mean length of stay, in-hospital case-fatality rate, 30-day readmission rate, and numbers and rates of emergency room visits. The researchers in this study concluded that, despite local and national efforts to reduce total hospitalizations and emergency department visits over the past decade, they have in fact increased for COPD, and the age-adjusted rates of hospitalizations and emergency department visits for COPD or bronchiectasis have not changed significantly in the United States during the period studied.
In spite of these findings, estimates from the Medicare Payment Advisory Commission indicate that up to 76% of COPD readmissions may be preventable. Elderly patients with COPD are less likely to be readmitted to the hospital by simply receiving quality nutrition treatment during their stay. It is noted that proper disease management extends beyond the confines of the hospital, as a previous study showed that one hands-on approach beneficial to some bronchiectasis patients is at-home intravenous antibiotic therapy.
The COPD Foundation is actively involved in helping patients reduce their hospital readmission rate. In October 2014, the foundation launched its Praxis (Prevent and Reduce COPD Admissions through expertise and Innovation Sharing) program, which is a focused effort of researchers from academia, healthcare, and industry to reduce COPD exacerbation-related hospital readmission. There are also regulations in place to fine hospitals with high rates of chronic lung disease patient hospital readmission, though this system may be flawed because the wrong facilities may actually be fined.
With clinical recognition of the hospital readmission rate for COPD and bronchiectasis, researchers continue to develop better methods to fully understand, treat, and prevent disease recurrence. In July 2014, researchers learned an important lesson from a study published in BMJ describing the results of “An Early Rehabilitation Intervention to Enhance Recovery During Hospital Admission for an Exacerbation of Chronic Respiratory Disease: Randomized Controlled Trial.” A total of 389 patients, 82% of whom had COPD, completed a prescribed regimen of progressive aerobic, resistance, and neuromuscular electrical stimulation training, along with a self management and education package. Contrary to the hypothesis, patients undergoing the intervention had greater mortality at 12 months, suggesting that progressive exercise rehabilitation alongside current standard physiotherapy practices may be dangerous for patients with early-stage acute illness.
Breathing Vests Could Potentially Cut Down on Hospital Readmissions for Bronchiectasis, COPD
While medical practitioners have therapeutics available to them for the treatment of both bronchiectasis and COPD, modern therapy for these diseases include a suite of treatment and care options that, when combined, can improve the quality of life of patients and reduce the number of visits made to the hospital due to exacerbations. In a guideline from the NIH’s National Heart, Lung, and Blood Institute, the use of “Chest Physical Therapy” (CPT) is suggested as one form of viable preventative care. Also known as “physiotherapy,” CPT makes use of percussive chest clapping to dislodge mucus in the lungs and air passages. Standard techniques involve a kind of percussive massage performed by a respiratory therapist or family member, but medical devices are now offering an alternative to this standard approach.
Often dubbed “breathing vests,” the NHLBI notes that an “inflatable therapy vest that uses high-frequency air waves” that can help “force mucus toward your upper airways so you can cough it up” is one viable choice for automating the CPT process, allowing patients to receive therapy while going about their normal lives. Past breathing vest designs included bulky, cumbersome external units that attach to the vest, providing air compression or vibration, however, next-generation designs such as the Afflovest offer a lightweight, compact, and untethered solution that allow for maximum mobility during treatment.
By using these vests, taking medication as prescribed, and eating a nutritious diet, patients with COPD and bronchiectasis will likely increase their quality of life and decrease the rate of hospital readmission.