Does involving a specialist in the management of COPD improve clinical outcomes? To find an answer to this question, researchers retrospectively reviewed the medical records of 290 patients with a known diagnosis of COPD hospitalized with acute exacerbation over two years. The outcomes of 198 patients who had a pulmonologist involved in their treatment within 24 hours of admission were compared with 92 patients who did not receive pulmonologist care and were managed by internists or residents. The findings were presented at Chest 2022, the recently held annual meeting of the American College of Chest Physicians in Hawaii.^1,2

Analysis revealed no significant difference in the length of stay between the two groups. The duration of hospitalization among the pulmonologist-treated patients, which was the primary endpoint of the study, was 4.16 days compared with 4.21 days in those treated by internists. The follow-up visit was earlier in patients in the pulmonologist group than those in the internist group (23 days vs 66 days, respectively) resulting in fewer rehospitalizations (30% versus ~58%, respectively), the secondary outcome of the study.

At the time of presentation the oxygen saturation among the pulmonologist-treated patients was 93% (average), while the oxygen saturation among the internist-treated patients was 95.4%. The severity of disease was however comparable between the two groups. 72% of patients treated by a non-pulmonologist needed to be hospitalized again at 90 days vs 28% of patients treated by a pulmonologist.

This study shows significant improvement in patient outcomes with a pulmonologist consultation compared to lack of specialist care. Patients with more severe exacerbations were the ones who benefited the most indicating the preference for a specialist consultation for more severe cases as evident by the lower mean oxygen saturation in patients treated by the pulmonologist.

These findings illustrate that a pulmonology referral at the earliest should be made a part of the treatment protocol for such patients. This would not only have a beneficial impact on the patient outcomes but also ease the burden on the already taxed healthcare system and resources.

References

1. Hossri S, et al. Correlation between pulmonologist consultation and outcomes on acute COPD exacerbations in hospitalized patients. Chest. 2022;162(4 Suppl): A1886. DOI:https://doi.org/10.1016/j.chest.2022.08.1572.
2. Pulmonologist consult at COPD admission reduces risk of return - Medscape - Nov 03, 2022.