JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
Abstract
Objectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in
internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes.
Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter
observational registry that enrolls inpatients aged 65 years.
Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD.
Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated
the occurrence of outcomes and its association with COPD and guideline adherence.
Results: At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD
patients were older, with more impaired clinical and functional status and multiple comorbidities.
Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD
guidelines. Polypharmacy (5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI):
2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking
habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were
associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD
during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all
causes (OR: 0.12, 95% CI: 0.02-0.90).
Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired
functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD
guidelines. Poor adherence to guidelines was associated with a worse clinical status. There is a need to improve adherence to guidelines in treating COPD patients, with the ultimate goal of reducing clinical
events.
