Get with the Guidelines: Comparing Management of COPD Treated in EDs in Europe and Australasia
Year: 2017
Type: article
Study design: Observational Study
Abstract: Objective: Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED).Recent Australian and European guidelines provide recommendations for management in the acute phase of care with the aim of optimizing outcomes.These include the administration of inhaled bronchodilators, corticosteroids and antibiotics and noninvasive ventilation (NIV) in patients with significant respiratory acidosis.The aim of this study was to compare management and outcomes between cohorts of patients treated for COPD in Europe (EUR) and South East Asia/ Australasia (SEA). Methods:In each region, we performed an observational prospective cohort study including consecutive patients presenting to EDs with dyspnoea as the main complaint during three 72-hour study periods.This study included the subset diagnosed with COPD.Data was collected on demographics, co-morbidities, chronic treatment, clinical features, treatment in the ED, ED diagnosis, disposition from ED and in-hospital outcome.The outcomes of interest for this study were comparison of treatments administered and outcome between EUR and SEA cohorts.Results: A total of 112 EDs participated -66 EUR and 46 SEA; 882 patients with COPD were studied (16% of total cohort).The cohorts were well matched for demographics and co-morbidities with the exception that significantly more in the EUR cohort were smokers (EUR vs. SEA for all comparisons; 43% vs 24%).While there was not a statistically significant difference in administration of bronchodilators (76% vs 80%), the proportion of administered corticosteroids was higher in the SEA cohort (52% vs 66%) as was administration of antibiotics (38% vs 49%).Rates of NIV and mechanical ventilation were similar.SEA had a higher hospital admission rate (70% vs 81%).In-hospital mortality was not significantly different (6% vs 4%).Conclusion: Compliance with guideline-recommended treatments was higher in the SEA cohort.That said, compliance with administration of corticosteroids and antibiotics was sub-optimal in both cohorts and represents an opportunity to improve care for this high-risk cohort of patients.
Authors: Anne‐Maree Kelly, Sai͏̈d Laribi
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2765600482