Abstract Rationale COPD Exacerbations (exacerbations) are important complications of COPD due to their negative impact on hospitalizations, healthcare costs, and death. Exacerbations are typically treated with corticosteroids after symptoms are reported to the healthcare system. Delays in treatment are important because they have been associated with increased hospitalizations. To date, no study has examined treatment delays after symptom reporting. This study tested the hypothesis that exacerbation treatment is prolonged and varies by treatment setting. Methods We performed an epidemiological study using UCHealth Epic® EMR data during 2023-2025 designed to measure the primary outcome, treatment-response-time (response-time), defined as the interval between symptom reporting and corticosteroid treatment. Secondary outcomes included patients treated on the day of, or days after (≥ 1), symptom reporting. Response-times based on treatment location were also examined. Inclusion criteria were: 1) age ≥ 40 years, 2) met criteria for the Epic COPD Registry, 3) treated for ≥ 5 days with systemic methylprednisolone, prednisolone or prednisone, and 4) patient messaging with the UCHealth system within the prior 14 days. Exclusion criteria were: 1) corticosteroid treatment within the past 30 days, 2) treatment department inconsistent with an exacerbation (i.e. Orthopedics), 3) outside hospital transfer or 4) admission from LTAC or SNF. Data are presented as mean (SD) or n (%). Results The study included 8,128 patients with a mean age of 70.3 (10.5) years; 4,605 (56.7%) females and 3,523 (43.3%) males. The population included 6,980 (85.9%) White, 405 (5.0%) Black, 23 (0.3%) Asian and 720 (8.9%) other/unknown; 570 (7.0%) were of Hispanic ethnicity. The overall mean response-time was 3.6 (4.3) days. Approximately two-thirds of patients were treated ≥ 1 day after symptom reporting (n = 5,174; 63.6%) with a mean response-time of 5.6 (4.3) days and maximum of 15 days. Overall, 1,463 (18.0%) were treated at home without an in-person visit with a response-time of 2.1 days (3.3), 2,844 (35.0%) during an office visit with response-time of 3.4 days (4.3), 1,609 (19.8%) in an ED with a response-time of 4.0 days (4.6), and 2,212 (27.2%) in a hospital with response-time of 4.5 days (4.5). Compared to home treatment, response-times for office visits, ED visits or hospitalization were significantly increased (p-value 0.001 for all). Conclusion Preliminary findings show that treatment is delayed for two-thirds of people with an exacerbation, and that response-times vary by treatment setting. Future analyses will validate the method used to identify COPD exacerbations and identify factors that may affect response-time. This abstract is funded by: None
Bolden et al. (Fri,) studied this question.