Published online: July 24, 2018
Early hospital readmission with a primary diagnosis of asthma and chronic obstructive pulmonary disease (COPD) is a major healthcare burden. Among clinical factors, different comorbid conditions (e.g., diabetes, obesity) significantly influence readmission. Besides other comorbidities, chronic rhinitis (CR) is significantly associated with lower respiratory conditions such as asthma or COPD. However, despite a significant clinical association between CR and these conditions, its influence in early asthma/COPD-related readmissions has not been previously investigated. This retrospective cohort study investigated the association of CR with the risk of asthma or COPD-related early hospital readmission rates.
This retrospective cohort study was performed by chart review and analysis of hospital encounter records for patients discharged from University of Cincinnati Hospitals with the diagnosis of asthma or COPD between June 15, 2012 and July 19, 2017. Hospital encounter data were extracted from the hospital practice using ICD-10-CM codes. For each patient, de-identified information on hospital encounter(s), demographics, pre-existing comorbidities (e.g., chronic rhinitis (allergic and non-allergic), cardiac arrhythmia, diabetes mellitus, hypertension, obesity, tobacco use), relevant clinical parameters at admission, and medications was obtained. Median follow-up time for asthma and COPD patients in the study were 980 and 553 days, respectively. The average number of asthma-related hospital admissions, within the study duration, for allergic rhinitis (AR) vs. non-rhinitis patients were 5.4 vs. 1.4 (p<0.0001). Compared to non-rhinitis patients, the adjusted hazard ratios for 30-day asthma-related readmission for AR or non-allergic rhinitis (NAR) patients were 4.4 or 3.7, respectively (p<0.0001), and for COPD-related 30-day readmission were 2.4 or 2.6, respectively (p<0.0001). Chronic rhinitis with peripheral eosinophilia was more significantly associated with acute asthma/COPD exacerbations than CR without peripheral eosinophilia.
Both AR or NAR were significantly associated with an increased risk of 30-day asthma- and COPD-related hospital readmissions. These findings emphasize the subcellular interactions between the upper and lower respiratory tracts which requires better elucidation in order to improve asthma and COPD outcomes. Longitudinal studies are needed to assess whether treatment of CR in hospitalized asthma and COPD patients has a significant impact on 30-day readmission rates. Until then, patients with these comorbidities should be properly diagnosed and treated for the appropriate CR subtype in the outpatient setting in an effort to reduce early hospital readmissions.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
Chronic rhinitis is a high-risk comorbidity for 30-day re-admission of patients with asthma and chronic obstructive pulmonary disease by Umesh Singh, Victoria Wangia-Anderson, Jonathan A. Bernstein