Olli Säynäjäkangas

High hospital burden in overlap syndrome of asthma and COPD

Overlap syndrome of asthma and chronic obstructive pulmonary disease (COPD) is a common condition, which is not well understood. This study describes the characteristics and hospital impact of patients suffering from this condition.

Bronchiectasis in Finland: trends in hospital treatment

The incidence of bronchiectasis has probably declined in developed countries in recent years, but no reliable statistical data on this are available. The present paper describes the use made of hospital services by bronchiectatic patients in Finland. Data on a total of 12,539 treatment periods for bronchiectasis that had occurred between 1972 and 1992 were collected from the discharge register maintained by the National Research and Development Centre for Welfare and Health (diagnosis 518 in the International Classification of Diseases up to 1986, and 494 from 1987 onwards). The number of admissions, new occurrences of bronchiectasis and days in hospital were calculated by sex and age in relation to the total population at the end of each year. There were 143 and 87 admissions per million inhabitants in 1972 and 1992, respectively. The admissions, new occurrences and the days in hospital all decreased, at annual rates of 1.3, 4.2 and 5.7%, respectively. Thus, where the number of new occurrences was 50 per million persons in 1977, it was 27 per million in 1992. In summary, bronchiectasis-related hospital treatment declined markedly between 1972 and 1992. Trend is attributed to effective treatment of pulmonary infections and the reduction in tuberculosis.

Links between hospital diagnoses of bronchiectasis and asthma

In view of the conflicting notions of the relationship between bronchiectasis and asthma, we have analysed the use of hospital services by bronchiectasis and asthma patients and evaluated the links between these diseases, employing data from the Finnish Hospital Discharge Register of over 21 million hospitalization periods recorded in 1972–92. We conclude that asthma is common in hospitalized bronchiectasis patients and appears to be consequent upon this disease.

Regional and seasonal variation in the length of hospital stay for chronic obstructive pulmonary disease in Finland

Notable regional and seasonal variation has been reported in the rate of hospital admissions for chronic obstructive pulmonary disease (COPE). The aim of this study was to assess the variation in the length of hospital stay for COPD in Finland on the north south axis and by season. For this purpose, the patient records of subjects aged over 45 hospitalised altogether 153,401 times with COPD as their primary diagnosis during 1987 - 1998 were retrieved from the Finnish Hospital Discharge Register maintained by the National Research and Development Centre for Welfare and Health. During this period, the average length of hospital episodes was 9.8 (SD) 47.8) days in northern Finland and 11.9 (SD 54.5) days in southern Finland (p = 0.001). Throughout Finland, the mean duration of hospital stay was longest in the winter, 12.3 (SD) 62.3) days, and shortest in the summer, 11.0 (SD) 42.3) days (p = 0.001). The mean duration of hospital stay in northern Finland was also longest in the winter, 10.6 (SD 56.7) days, and shortest in the summer, 8.8. (SD) 26.7) days (p = 0.015). Hospital episodes for COPD vary in duration in Finland, probably mainly due to regional differences in health care resources and treatment routines. The light and warm northern summer may also speculatively serve to shorten hospital episodes.

Is the treatment of acute COPD exacerbations in Finland shifting to general practitioners

Objective. To examine changes in the numbers of inpatient episodes and inpatient days and length of stay in acute exacerbations of COPD (chronic obstructive pulmonary disease) by specialization and by age group and sex distribution relative to the total population in the years 1995–2001. Design. A register-based study. Subjects. Data on inpatient episodes for patients aged 45 years or over with a principal diagnosis of COPD beginning in 1995–2001 and lasting less than 90 days were extracted from the hospital discharge register of the Finnish National Research and Development Centre for Welfare and Health. Main outcome measures. Numbers of inpatient episodes and days by age and sex in the specialities of general practice, pulmonary medicine, and internal medicine. Results. The annual number of inpatient episodes increased by 10.9% from 1995 to 2001. The number of emergency treatment episodes supervised by a general practitioner increased by 36.8% during the same period and the number of such episodes supervised by a pulmonary specialist by 17.8%. The increase in age-adjusted emergency treatment episodes for men was 0.8% and that for women 18.5%. The average hospital stay shortened from 8.0 (SD 8.0) to 6.5 (SD 6.2) for men and from 8.7 (SD 8.5) to 7.3 (SD 6.8) for women. Conclusions. The greater increase in inpatient episodes for exacerbations of COPD in relation to the total population among women than among men may be attributed to differences in smoking habits and ageing between the sexes. Responsibility for COPD cases is clearly shifting to general practitioners. This is due partly to the national programme for the treatment of obstructive pulmonary diseases and the associated in-service training provided for general practitioners and partly to financial reasons. More detailed investigations should be made into the quality of the treatment.

Differences in COPD-related readmissions to primary and secondary care hospitals

Objective. To study differences in readmissions to primary and secondary care hospitals for exacerbations of chronic obstructive pulmonary disease (COPD). Design. A register-based study. Subjects. The data were gathered from the hospital admissions register of the Finnish National Research and Development Centre for Welfare and Health. The data included all acute periods of treatment received by COPD patients aged over 44 years in 1996–2004 who had a principal or subsidiary diagnosis of COPD (ICD 10: J41–J44), respiratory infection (ICD 10: J00–J39, J85–J86) or cardiac insufficiency (ICD 10: I50), followed by an emergency readmission. Treatment had to have taken place in either a primary care hospital or a specialized ward for respiratory diseases or internal medicine in a secondary care hospital. Main outcome measures. The risk of readmission within a week of discharge, analysed by site of care. Results. The risk of readmission within seven days of discharge is 1.74-fold for a patient treated in primary care compared with a patient treated in secondary care. Conclusions. COPD patients discharged from primary care hospitals have a greater risk of readmission, particularly within a week, than those discharged from secondary care. This risk may be attributed to differences in treatment procedures and arrangement of subsequent care. Thus, in the future, more attention should be paid to primary healthcare resources and staff training.

Does place of treatment affect prognosis for chronic obstructive pulmonary disease (COPD)

Background: It has been shown previously that mortality from acute chronic obstructive pulmonary disease (COPD) is higher at small hospitals than at large teaching hospitals. Objective: To examine mortality at this acute stage and referral for further treatment by specialities in Finland, and trends in these between the 1990s and 2000s. Methods: Data on all periods of treatment for patients over 44 years of age with a principal or subsidiary diagnosis of COPD beginning and ending in 1995–2004 were extracted from the Finnish hospital discharge register. Particular attention was paid to acute-stage treatment periods managed by a general practitioner, pulmonary specialist, or specialist in internal medicine that had begun as emergency admissions and had a principal diagnosis of COPD, and to any further treatment immediately following these. Results: General practitioners referred 5.1% of their acute-stage patients to a specialist in secondary care in 1995–2004. Of the total of 77 445 acute-stage treatment periods, 3% (2328) ended in the death of the patient, implying the loss of 8.3% of the patients involved. The age- and sex-adjusted risk of death attached to treatment periods managed by a general practitioner relative to those managed by a pulmonary specialist was 0.83 (95% CI 0.75–0.91). Conclusion: It is quite possible to treat acute exacerbations of COPD efficiently and safely in a health centre hospital ward. New treatment modalities and health service structures seem to have led to a decrease in acute exacerbations of COPD since the year 2000, even though the number of patients with this disease has increased as a consequence of ageing of the population. Further research is required on the efficacy of treatment by a general practitioner, e.g., with data on re-hospitalization.