Chronic obstructive pulmonary disea...

Chronic obstructive pulmonary disease (COPD) accounts for approximately 1 million crisis department visits per year. Given the high rates of hospitalization and the charge of caring for patients with COPD Cydulka and colleagues administrationed a study to determine whether exigency department treatment of COPD was in accordance with published guidelines.

The application of mind combined data from two prospective cohort studies that were part of the Multicenter Airway Research Collaboration, involving 29 conjuncture departments in the United States and Canada. Patients with COPD and relevant characteristics, including information forward outcomes, were identified through chart review and follow-up telephone interviews. Adherence to five published COPD guidelines forward evaluation and treatment was assessed. Evaluation constituents included use of spirometry, arterial kindred gas measurement, sputum testing, and chest radiography. Treatment elements included use of inhaled beta agonists, anticholinergic agents, methylxanthines, systemic corticosteroids, and antibiotics.

Analysis was performed forward 397 mixed COPD-asthma and COPD-only patients. chiefly patients had severe disease and eventually required hospitalization. Peak expiratory deliquesce was obtained in 32 percent of the patients, and sole 10 percent of values measured forced expiratory body in one second. Adherence to evaluative aspects of the five guidelines was reasonable Objective measurement of pulmonary function, commended by all five guidelines, was obtained in 43 percent of patients with mixed disease and in 21 percent of COPD-only patients. individual half of patients received commended blood gas evaluation. Sputum testing was 6 and 7 percent respectively. Chest radiography was performed in 87 percent of the patients.

Patients were given no other than a median of one short-acting beta-agonist treatment in the first hour of sudden [i]or[/i] unexpected occurrence care. While patients with mixed disease received an anticholinergic aerosol during the first hour of care, no COPD-only patients received this medication. merely one patient received a methylxanthine. Overall, 62 percent were treated in the conjuncture department with a systemic corticosteroid, 28 percent received antibiotics in the pinch department, and 24 percent of nonadmitted patients received them at discharge. Adherence to the five guidelines regarding treatment was subdued Finally, 43 percent of patients reported a relapse adventure or ongoing exacerbation at the two-week follow-up More patients with mixed disease experienced relapse than COPD-only patients, and the two groups experienced ongoing exacerbation equally.

The authors fix low adherence to published guidelines, with considerable potential for improved urgency department care. It is likely that these findings throw back inconsistency among guidelines, resulting in confusion about correct management. The role and use of spirometry, in particular, remain controversial. Agreement among guidelines is greatly greater regarding treatment--currently supporting the use of inhaled anticholinergics and antibiotics for initial treatment--but adherence in pinch departments was low in this area as well. Emphasis in succession adaptable guidelines and improved guideline adherence may lead to improved clinical outcomes

Cydulka RK et al. crisis department management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: the Multicenter Airway Research Collaboration. J Am Geriatr Soc July 2003;51:908-16

COPYRIGHT 2004 American Academy of Family Physicians

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