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A6740 - Community Acquired Respiratory Illness as a Co-Morbidity for COPD Patient Readmission - Case Review 2017
Author Block: S. Morgan, S. Moskowski, S. Melinauskas, J. Eichorst; Respiratory Care, University of Chicago, Chicago, IL, United States.
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by irreversible air-flow limitations. COPD is the third leading cause of death in the United States of America (USA), viral related respiratory illness may be the etiology for increase mortality. COPD patients are at a higher risk for acquiring community acquired respiratory illness, because of a weaken immune system. Respiratory viral infections are highly contagious and easily transmitted via airborne or contact and is now documented to be caused by multiple viral pathogenic agents capable of triggering life threatening events. Hospitals in the USA are penalized when patients are readmitted before a 30d window is met with penalties and decreased payment reimbursement. Clinical involvement of influenza or zoonotic pathogens is under recognized as a co-contributor to re-admission for they often present as asthma-like syndromes. They were identified via respiratory care treatment orders and diaagnoses. Case Reviews: Six patients with prior history of COPD were hospitalized during 2017. These patients were admitted for mild to moderated COPD exacerbations. All patients had received their seasonal flu vaccinations. As part of initial screening, a respiratory viral panel (RVP) was obtained. The microbiology methodology test use to verify the viral pathogens was Polymerase Chain Reaction (PCR). Many viral agents outside of the influenza pathogens have been identified such as; rhinovirus and respiratory enterovirus (D68) was the leading cause for admissions, followed by coronavirus (HCoV-OC43). These six patients were identified by respiratory care treatment orders and diagnoses. The six patients were hospitalized for 3-5 days and discharged home. Four of these patients were readmitted prior to thirty day’s elapsing with recurrent COPD exacerbations. Conclusion; Rhinovirus / enterovirus may be the cause of admission with COPD like exacerbation during different times of the year. It may be possible for patients to be re-infected once they are discharged home after the first hospital admission. For unexplained increased dyspnea in COPD patients, a RVP is recommended for verification of viral respiratory illness. It may be prudent to pay particular attention and closely follow these patients after discharge to prevent readmission