Summary

Complexity of maintenance treatment as a predictor of 30-day deterioration in chronic obstrutive pulmonary disease (COPD) exacerbations in the emergency department

Raúl Alonso Avilés1,2, Carlos Del Pozo Vegas1-3, José Eugenio Lozano Alonso4, Marina Jimeno Asensio1, Alberto Gómez de Diego1,2, Alberto Caballero García4,5, José Ramón Casal Codesido6, Ramón Rodríguez Borrego7,8, Carmen Peñalver Barrios9, Mónica De Diego Arnáiz10, Raúl López Izquierdo2,3,11,12

Affiliation of the authors

1Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Spain. 2Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Spain. 3Instituto de Investigación Biosanitaria de Valladolid (IBIoVALL), Valladolid, Spain. 4Instituto de Ciencias de la Salud de Castilla y León, Valladolid (ICSCYL), Spain. 5Departamento de Anatomía y Radiología, Facultad de Medicina, Universidad de Valladolid, Spain. 6Servicio de Urgencias, Hospital El Bierzo, Ponferrada, Spain. 7Servicio de Urgencias, Complejo Asistencial Universitario de Salamanca, Spain. 8Departamento de Medicina, Facultad de Medicina, Universidad de Salamanca, Spain. 9Servicio de Urgencias, Complejo Asistencial Universitario de Segovia, Spain. 10Servicio de Urgencias, Complejo Asistencial Universitario de Burgos, Spain. 11Hospital Universitario Río Hortega, Valladolid, Spain. 12Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.

DOI

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Alonso Avilés R, Del Pozo Vegas C, Lozano Alonso JE, Jimeno Asensio M, Gómez de Diego A, Caballero García A, et al. Complexity of maintenance treatment as a predictor of 30-day deterioration in chronic obstrutive pulmonary disease (COPD) exacerbations in the emergency department. Emergencias. 2026;38:179-85

Summary

Objective.

Maintenance treatment patterns in chronic obstructive pulmonary disease (COPD) may reflect disease severity beyond the usual indicators used in emergency departments (EDs). The objective of this study was to evaluate whether treatment complexity predicts 30-day clinical deterioration.

Methods.

We conducted a prospective multicenter cohort study including patients aged $ 40 years presenting to 14 EDs with acute exacerbation of COPD confirmed by spirometry (post-bronchodilator FEV1/FVC < 0.7) or clinically suspected COPD (sCOPD: $ 10 pack-years with chronic respiratory symptoms). Treatment intensity was categorized as none, monotherapy, dual therapy, triple therapy, or multiple therapy ($ 4 drugs). The primary endpoint was a 30- day composite of therapeutic intensification, ED revisit, hospitalization, or death. Multivariable mixed-effects logistic regression was performed, adjusting for age, sex, comorbidity (Charlson Comorbidity Index), functional status (Barthel Index), and exacerbation severity, with a random intercept for hospital.

Results.

The median age was 75 years (IQR, 67–81). The composite endpoint occurred in 381 of the 1179 patients included (32.3%). After adjustment for age, sex, comorbidity, functional status, exacerbation severity, and hospital center, triple therapy (adjusted odds ratio [aOR], 2.20; 95% CI, 1.24–4.08; P = .009) and multiple therapy (aOR, 2.34; 95% CI, 1.32–4.34; P = .005) were associated with an increased risk of deterioration. The multivariable model showed adequate discriminative ability (C statistic = 0.71; 95% CI, 0.67–0.75).

Conclusions.

Treatment complexity predicted 30-day deterioration, likely reflecting underlying disease severity not captured by conventional measures rather than a causal effect of treatment.

 

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