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Hospitalizations and ED Visits in COPD: A Collision of Socioeconomic Realities with Chronic Comorbid Medical Illnesses.

Treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represents the major cost associated with this condition, primarily because of overuse of hospital and emergency department (ED) resources.1-3 Although hospitalization and ED-based care is needed in urgent situations that fail optimal therapy, many hospitalizations and re-hospitalizations stem from failure to receive optimal outpatient care. A number of pharmacologic interventions including bronchodilators, corticosteroids, phosphodiesterase-4 inhibitors, and macrolide antibiotics have been shown to reduce the frequency of COPD exacerbations but none has been consistently shown to substantially reduce the rates of hospitalization.4 Similarly, the effects of pulmonary rehabilitation and disease management programs have shown inconsistent impact on hospital utilization rates.5-7 However, new drugs or treatments may not be the answer. No matter how good a COPD therapy is, if patients cannot or do not receive it, hospital and ED admission rates will remain unchanged. Understanding who the patients are that require hospital or ED admission will hopefully facilitate creative multimodality approaches to solve this problem. In this issue of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation Kumbhare and colleagues report on their analysis of data from the 2012 Behavioral Risk Factor Surveillance System survey where respondents completed the optional COPD module questions. Their findings mostly support the conclusions of other investigators who have shown increased risk for exacerbations that require hospitalization for those COPD patients who have multiple comorbidities, low physical activity, and lower socioeconomic status. They were surprised to find that there were no differences in tobacco use between those admitted for COPD exacerbation and those who were not and that those who were admitted to the hospital were younger than those not admitted. While no one can argue the general negative effects of smoking, it is quite possible that those not admitted to the hospital continued to smoke simply because their disease, while present, was not severe enough to result in hospitalization. Also, while increasing age does generally correlate with increased rates of COPD hospitalization, older age has also been shown to have 2 Department of Pharmacy Practice, School of Pharmacy, Temple University, Philadelphia, Pennsylvania