Chronic Rhinitis Significantly Associated With Early Hospital Readmission Rates for Asthma and COPD

Early hospital readmissions for patients with asthma and chronic obstructive pulmonary disease (COPD) represent a major economic burden within the healthcare system. Researchers recently found that comorbid chronic rhinitis (CR) is significantly associated with 30-day asthma and COPD related readmissions.

The study involved asthma and COPD-related hospital encounters and patient comorbidity data from University of Cincinnati Hospitals between June 15, 2012, to July 19, 2017. The researchers used International Classification of Diseases, Tenth Revision, Clinical Modification codes to identify patients with a primary discharge diagnosis of asthma and COPD, and to identify relevant comorbidities, including allergic rhinitis (AR) or nonallergic rhinitis (NAR).

“Unplanned early hospital readmissions can quickly and significantly overwhelm healthcare resource utilization while further diminishing the patient’s disability and quality of life. One approach to easing the health care burden of 30-day readmission rates is to better control acute exacerbations,” explained the authors. “Therefore, concerted efforts to understand factors contributing to acute exacerbations resulting in unplanned readmissions is critical.”

Early hospital readmissions for asthma and COPD were defined as hospital readmission within 30-days from the last discharge. The researchers used Cox proportional hazards models to determine the association between 30-day asthma or COPD-related hospital readmission and comorbid CR in the affected patients. The study also compared the readmissions of patients with CR with those who didn't have CR using multivariate-adjusted hazard ratios (HRs).

A total of 4754 asthma patients and 2176 COPD patients were included in the analysis. The HRs for 30-day asthma or COPD-related readmission rates were found to be significantly higher in patients with AR or NAR, when compared with patients who did not have rhinitis. Specifically for asthma, both AR and NAR had higher HRs compared with every other commodities that were considered. For COPD, AR and NAR had HRs to the magnitude of obesity and hypertension, according to the results.

“Both AR or NAR was significantly associated with an increased risk of 30-day asthma- and COPD-related readmission. These findings emphasize the subcellular interactions between the upper and lower airways which needs to be better elucidated in order to improve asthma and COPD outcomes,” the authors concluded. “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 researchers emphasized the need for future longitudinal studies in order to assess whether treatment of CR in hospitalized asthma and COPD patients has a significant impact on 30-day readmission rates.

Reference

Singh U, Wangia-Anderson V, Bernstein JA. Chronic rhinitis is a high-risk comorbidity for 30-day readmission of patients with asthma and chronic obstructive pulmonary disease. J Allergy Clin Immunol Pract. doi: 10.1016/ j.jaip.2018.06.029.