Lung
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Global Initiative on Chronic Obstructive Lung Disease (GOLD) guidelines recently removed stage 0, a group with symptoms but without airways obstruction, from their severity staging. However, in practice this group may still be diagnosed and medically managed. The aim of this study was to characterize healthcare utilization patterns of chronic obstructive pulmonary disease (COPD) patients by disease severity, focusing on the possible unique attributes of patients who would have been classified as GOLD stage 0. ⋯ The "at risk" group had an average of 14.4 (SD = 30.5) outpatient visits/year and 0.3 (SD = 0.8) hospitalizations/year, which were higher than the other groups, but this was not statistically significant. Respiratory medications were used by 6 (26%), 30 (59%), and 40 (91%) patients from "at risk" to GS 3-4, respectively. Patients in the "at risk" group had a decrement in health status, significant utilization of healthcare services, and were often receiving medications not consistent with guidelines.
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The poor long-term survival of patients requiring prolonged mechanical ventilation may be due to potentially modifiable factors. We therefore sought to assess the early determinants of long-term survival after discharge from a specialized respiratory unit. ⋯ Mortality after discharge from a respiratory care unit is high. Interventions that may favorably impact long-term survival in these patients could target the modifiable factors identified, including measures that facilitate weaning and prevent or treat renal dysfunction and skin breakdown.