Neel, Sejal

Abstract Introduction: Chronic Obstructive Pulmonary Disease (COPD) exacerbations increase inflammation, immobilization, and thrombotic risk, leading to a higher incidence of pulmonary embolism (PE). This study evaluates the incidence and risk of PE in patients with acute exacerbations of COPD (AECOPD) compared to those without exacerbations. Methodology: This retrospective cohort study utilized data from 94 healthcare organizations, identifying two cohorts: patients with AECOPD and those without exacerbations. Inclusion was based on ICD-10-CM codes, and individuals with malignancies, coagulation disorders, or prior PE were excluded. Propensity score matching was performed to balance the cohorts on demographics, clinical characteristics, and medications. The primary outcome was PE incidence, analyzed using risk differences, risk ratios, odds ratios, and Kaplan-Meier survival analysis to evaluate mortality outcomes associated with PE. Results: After matching, both cohorts comprised 174,345 patients each. The mean age was approximately 73 years, with a slight female predominance (49.0% in AECOPD vs. 49.3% in non-AECOPD). The incidence of PE was significantly higher in the AECOPD cohort (15%) compared to the non-AECOPD cohort (8%) (p < 0.001). Specifically, 2,162 patients (1.3%) in the AECOPD cohort developed PE, compared to 1,467 patients (0.9%) in the non-AECOPD cohort. The risk difference was 0.004 (95% CI: 0.003, 0.005; p < 0.001). The risk ratio for PE in the AECOPD cohort was 1.477 (95% CI: 1.382, 1.577), and the odds ratio was 1.483 (95% CI: 1.387, 1.585). Survival analysis revealed a probability of 95.23% in the AECOPD cohort and 97.15% in the non-AECOPD cohort, with significant differences (χ² = 153.746, df = 1, p < 0.001). The hazard ratio for mortality associated with PE was 1.517 (95% CI: 1.419, 1.621). Conclusion: Patients with AECOPD have a significantly higher incidence of pulmonary embolism compared to those without exacerbations. PE is often overlooked in AECOPD patients due to the overlap in clinical symptoms, making timely diagnosis and treatment challenging. This can result in delayed management and poor outcomes. Therefore, it is crucial to enhance understanding of the clinical manifestations, diagnosis, and treatment of COPD complicated by PE to improve diagnostic accuracy, ensure timely intervention, and optimize patient prognosis.

Abstract Background: Pulmonary rehabilitation (PR) is a comprehensive intervention and essential component for integrated care with patients with chronic respiratory diseases, especially Chronic Obstructive Pulmonary Disease (COPD). American Thoracic Society (ATS) strongly recommends PR for patients with COPD after exacerbation. PR has been shown to reduce mortality, improve quality of life, and decrease hospital readmissions in patients with COPD. Despite these benefits, access to PR remains unevenly distributed, particularly among racial and ethnic minorities. This study explores racial and ethnic disparities in PR utilization among COPD patients with a history of exacerbations. Methods: Utilizing data from the TrinetX Research Network, we examined two cohorts of COPD patients. Cohort 1 (N=493) consisted of patients with COPD and prior exacerbations who received PR, while Cohort 2 (N=457,573) included similar patients who did not receive PR. Demographics, specifically, race and ethnicity, were statistically analyzed to assess the presence and significance of disparities, using chi-square tests and standardized mean differences (SMD) to provide a comparative framework.Results:493 patients were in the PR group and 457,573 patients in the non-PR group, comprising 458,066 patients across both cohorts. Among the 493 patients in the PR cohort, the largest group was categorized as Other Race (192 patients, 38.9%, p < 0.001, SMD = 1.040), followed by White patients (154 patients, 31.2%, p < 0.001, SMD = 0.899). Black or African American and Asian patients were both minimally represented, with 10 patients each (2.0%, p < 0.001, SMD = 0.319 and SMD = 0.034, respectively), while 137 patients (27.8%, p < 0.001, SMD = 0.349) were of Unknown Race. In contrast, the non-PR cohort, comprising 470,239 patients, had a substantially higher proportion of White patients (330,409 patients, 72.2%) and a significantly greater representation of Black or African American individuals (42,573 patients, 9.3%, p < 0.001, SMD = 0.319) and Hispanic or Latino individuals (13,709 patients, 3.0%, p < 0.001, SMD = 0.249) compared to the PR cohort. Conclusion: This study highlights significant disparities in the utilization of PR among COPD patients, with underrepresented racial and ethnic groups demonstrating lower access to this intervention. These findings highlight the need for targeted strategies to address potential barriers to PR, promoting equitable access across diverse populations. Further investigation into structural and socioeconomic factors influencing PR access will be crucial to fostering inclusive care and reducing healthcare disparities in COPD management.