Chronic Rhinitis Is A High-Risk Comorbidity For 30-Day Re-Admission Of Patients With Asthma And Chronic Obstructive Pulmonary Disease

Publication date: Available online 25 July 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Umesh Singh, Victoria Wangia-Anderson, Jonathan A. Bernstein

ABSTRACT

BACKGROUND

Early hospital readmissions for asthma and chronic obstructive pulmonary disease (COPD), measured as hospital readmission within 30 days from the last discharge, is a major economic burden to our healthcare system. Association of this measure with comorbid chronic rhinitis (CR) has not been investigated before despite significant clinical association between CR and asthma or COPD.

OBJECTIVE

To investigate the association of CR with the risk of asthma or COPD-related early hospital readmission rates.

METHODS

This retrospective cohort study was performed using the asthma- and COPD-related hospital encounter and patient comorbidity data between June 15, 2012 - July 19, 2017 from a large hospital care system in Cincinnati, Ohio. Patients (any gender, race or socioeconomic status, and of all ages) with a primary discharge diagnosis of asthma (n=4754 patients, 10,111 encounters) and COPD (n=2176 patients, 4,748 encounters) based on ICD-10-CM codes were included. Relevant comorbidities, including comorbid allergic rhinitis (AR) or non-allergic rhinitis (NAR), in such patients were identified using ICD-10-CM codes. The association between 30-day asthma or COPD-related hospital readmission (1,670 such encounters for asthma and 736 for COPD) and comorbid CR in the affected patients were determined using Cox proportional hazards models. Multivariate-adjusted hazard ratios (HR), adjusted for relevant patient comorbidities, compared 30-day asthma- and COPD-related readmissions of patients with CR with those patients without a CR diagnosis.

RESULTS

Analysis was performed on 4,754 asthma and 2,176 COPD patients. The median follow-up period (+interquartile range) for asthma was 980 (+760) days and for COPD was 553 (+827) days. The HR for 30-day asthma- or COPD-related readmission rates were significantly higher in patients with AR [HR=4.4 (3.9, 5.0) and 2.4 (1.7, 3.2), respectively] or NAR [HR=3.7 (2.9, 4.9) and 2.6 (1.8, 3.7), respectively) compared to non-rhinitis patients. For asthma, both AR and NAR had higher HRs compared to all other co-morbidities analyzed. For COPD, both AR and NAR had HRs to the magnitude as obesity and hypertension.

CONCLUSION

AND RELEVANCE: Comorbid CR is significantly associated with 30-day asthma- and COPD-related readmissions. These findings are useful for guiding healthcare professionals to focus on outpatient management of both the upper and lower respiratory tracts in order to reduce early readmission of asthma and COPD patients.