Management of Chronic Obstructive Pulmonary Disease Exacerbations: How Well Are We Doing?

Chronic obstructive pulmonary disease (COPD) affects a significant proportion of the general Canadian population, with recent population-based prevalence estimates ranging from approximately 4% to 10% (1-3). COPD is commonly characterized by acute exacerbations, sustained worsenings of respiratory symptoms leading to an increase in the use of maintenance medications and/or supplementation with additional medications (4). Although highly variable, the average COPD patient with moderate-to-severe airflow reduction experiences two to three exacerbations per year (5). COPD exacerbations requiring hospitalization are associated with increased mortality (6). Prompt and appropriate treatment of exacerbations can improve quality of life and lower hospitalization risk (7). There are relatively few studies examining the quality of medical care COPD patients receive during acute exacerbations (8-9). These studies have often focused only on pharmacotherapy management and have revealed suboptimal care such as reduced systemic corticosteroid and antibiotic prescription (8-9).