Review of the Clinical Characteristics Associated With Prophylactic Azithromycin Use in Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Bibliographic record
Abstract
Abstract Rationale: Some patients may continue to experience acute exacerbations of chronic obstructive pulmonary disease (AECOPD) even when prescribed inhaled triple therapy (LAMA/LABA/ICS). The Global Initiative for Chronic Obstructive Lung Disease and Canadian Thoracic Society statements recommend considering additional oral therapies for these patients. This review aimed to identify which subjects hospitalized for severe AECOPD were more likely to receive prophylactic azithromycin and to compare readmission rates up to 3 months after discharge. Methods: Patients hospitalized in 2022 and 2023 for severe AECOPD at Montfort Hospital (Ottawa, Ontario, Canada) were retrospectively reviewed. Demographic information collected included age, sex, and cigarette smoking status/history. Respiratory medications were charted, in addition to home supplemental oxygen use. Spirometry results on file and blood eosinophil counts (BEC) in the past year were also recorded. Readmissions for AECOPD were documented. Comparisons were performed using a t-test for mean results and a chi-square test for the dichotomous variables (significant relationship if p<0.05). Results: Out of 348 patients treated for severe AECOPD (13 deaths), 175 (50%) were on inhaled LAMA/LABA/ICS at the time of hospitalization. 36 subjects were prescribed prophylactic azithromycin, 19% of those on inhaled triple therapy (2/36 were on inhaled LAMA/LABA). Subjects receiving azithromycin had longer hospital length of stay (LOS), were more likely to be ex-smokers, and to use home supplemental oxygen. Furthermore, a greater proportion of patients had a charted BEC ≥0.3x109/L. No significant relationship was found with age, sex, pack-year smoking history, or % predicted FEV1 (although limited data available). Notably, patients prescribed prophylactic azithromycin were more likely to be readmitted for AECOPD within 3 months, 13/35 (37%; 8/17 with BEC ≥0.3x109/L) versus 24/132 (18%), p=0.02. (Table 1) Conclusion: The prescription of azithromycin appeared to be influenced by the current smoking status and clinical characteristics associated with more severe disease (hospital LOS and home supplemental oxygen use). Half of patients on azithromycin had elevated BEC (≥0.3x109/L) and could potentially benefit from biologic medications treating type 2 inflammation once these therapies are approved in Canada for COPD.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".