Abstract
Introduction: Natural history of chronic obstructive pulmonary disease (COPD) is characterized by a progressive decline in pulmonary function and recurrent exacerbations, requiring frequent hospital admissions to medical wards. Great heterogeneity still exists between studies hindering our understanding of the true, global burden of AECOPD on healthcare systems over COVID-19 pandemic. We aimed to describe the AECOPD in the southern Italian region from 2017 to 2022 and to detail the location of admission, rate and characteristics of deaths, and use of noninvasive respiratory supports. Methods: Retrospective, cross-sectional study carried out in collaboration with the Apulian Regional Observatory for Epidemiology over the second semester of 2023. Selected records with specific ICD-9 codes related to AECOPD and its clinical details, related complications, number of re-hospitalization, and noninvasive respiratory support use described as “principal” or “secondary” or “other diagnosis” were considered. Results: From 2017 to 2022, a total of 29,917 patients with AECOPD were admitted to hospital, and they generated a total of 44,260 hospitalizations. The male gender represented 60.9% of the total, mean age 77.1 ± 11.2 years. Deaths were 3,743, complicated by other comorbidities in 54% of cases. Readmissions rate was 8.5%. Deaths allocation was as follows: intensive care 37.7%, general medicine 33%, respiratory ward 13.5%, etc. Noninvasive respiratory supports were used in 47% of cases. Conclusion: This prolonged and deeply characterized clinical observation of AECOPD admissions, including COVID-19 pandemic years, in Apulia region, shows that they present at older age, affected by one\more comorbidities with more severe disease requiring in almost half a percentage of cases the use of respiratory support (HFNC and NIV). However, the high rate of deaths highlights the urgent need to further support the most severe cases who deserve more tailored ward allocation and care management.
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