Management of acute COPD exacerbations in Australia : Do we follow the guidelines?

Journal article


Cousins, Joyce L., Wood-Baker, Richard, Wark, Peter A. B., Yang, Ian A., Gibson, Peter G., Hutchinson, Anastasia, Sajkov, Dimitar, Hiles, Sarah A., Samuel, Sameh and McDonald, Vanessa M.. (2020). Management of acute COPD exacerbations in Australia : Do we follow the guidelines? ERJ Open Research. 6(2), pp. Article 00270-2019. https://doi.org/10.1183/23120541.00270-2019
AuthorsCousins, Joyce L., Wood-Baker, Richard, Wark, Peter A. B., Yang, Ian A., Gibson, Peter G., Hutchinson, Anastasia, Sajkov, Dimitar, Hiles, Sarah A., Samuel, Sameh and McDonald, Vanessa M.
Abstract

Objective
We aimed to assess adherence to the Australian national guideline (COPD-X) against audited practice, and to document the outcomes of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (COPD) at discharge and 28 days after.

Methods
A prospective clinical audit of COPD hospital admission from five tertiary care hospitals in five states of Australia was conducted. Post-discharge follow-up was conducted via telephone to assess for readmission and health status.

Results
There were 207 admissions for acute exacerbation (171 patients; mean 70.2 years old; 50.3% males). Readmission rates at 28 days were 25.4%, with one (0.6%) death during admission and eight (6.1%) post-discharge within 28 days. Concordance to the COPD-X guidance was variable; 22.7% performed spirometry, 81.1% had blood gases collected when forced expiratory volume in 1 s was <1 L, 99.5% had chest radiography performed, 95.1% were prescribed systemic corticosteroids and 95% were prescribed antibiotic therapy. There were 89.1% given oxygen therapy and 92.6% when arterial oxygen tension was <80 mmHg; 65.6% were given ventilatory assistance when pH was <7.35. Only 32.4% were referred to pulmonary rehabilitation but 76.8% had general practitioner follow-up arranged.

Conclusion
When compared against clinical practice guidelines, we found important gaps in management of patients admitted with COPD throughout tertiary care centres in Australia. Strategies to improve guideline uptake are needed to optimise care.

Year2020
JournalERJ Open Research
Journal citation6 (2), pp. Article 00270-2019
PublisherEuropean Respiratory Society
ISSN2312-0541
Digital Object Identifier (DOI)https://doi.org/10.1183/23120541.00270-2019
PubMed ID32337215
Scopus EID2-s2.0-85094887898
PubMed Central IDPMC7167211
Open accessPublished as ‘gold’ (paid) open access
Page range1-9
FunderNational Health and Medical Research Council (NHMRC)
AstraZeneca
GlaxoSmithKline
Boehringer Ingelheim
Novartis
Menarini
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online19 Apr 2020
Publication process dates
Accepted18 Feb 2020
Deposited07 Apr 2025
Additional information

Copyright © ERS 2020 This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0 (https://creativecommons.org/licenses/by-nc/4.0/).

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