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Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub‐optimal
Author(s) -
Kelly AnneMaree,
Van Meer Oene,
Keijzers Gerben,
Motiejunaite Justina,
Jones Peter,
Body Richard,
Craig Simon,
Karamercan Mehmet,
Klim Sharon,
Harjola VeliPekka,
Verschuren Franck,
Holdgate Anna,
Christ Michael,
Golea Adela,
Graham Colin A.,
Capsec Jean,
Barletta Cinzia,
GarciaCastrillo Luis,
Kuan Win S.,
Laribi Said
Publication year - 2020
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14323
Subject(s) - medicine , copd , guideline , emergency department , antibiotics , prospective cohort study , cohort , emergency medicine , respiratory acidosis , observational study , mechanical ventilation , cohort study , intensive care medicine , respiratory system , pathology , psychiatry , microbiology and biotechnology , biology
Abstract Background Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED). Guidelines recommend administration of inhaled bronchodilators, systemic corticosteroids and antibiotics along with non‐invasive ventilation (NIV) for patients with respiratory acidosis. Aim To determine compliance with guideline recommendations for patients treated for COPD in ED in Europe (EUR) and South East Asia/Australasia (SEA) and to compare management and outcomes. Methods In each region, an observational prospective cohort study was performed that included patients presenting to ED with the main complaint of dyspnoea during three 72‐h periods. This planned sub‐study included those with an ED primary discharge diagnosis of COPD. Data were collected on demographics, clinical features, treatment, disposition and in‐hospital mortality. We determined overall compliance with guideline recommendations and compared treatments and outcome between regions. Results A total of 801 patients was included from 122 ED (66 EUR and 46 SEA). Inhaled bronchodilators were administered to 80.3% of patients, systemic corticosteroids to 59.5%, antibiotics to 44 and 60.6% of patients with pH <7.3 received NIV. The proportion administered systemic corticosteroids was higher in SEA (EUR vs SEA for all comparisons; 52 vs 66%, P < 0.001) as was administration of antibiotics (40 vs 49%, P = 0.02). Rates of NIV and mechanical ventilation were similar. Overall in‐hospital mortality was 4.2% (SEA 3.9% vs EUR 4.5%, P = 0.77). Conclusion Compliance with guideline recommended treatments, in particular administration of corticosteroids and NIV, was sub‐optimal in both regions. Improved compliance has the potential to improve patient outcome.