PURPOSE: COPD is an increasing cause of morbidity, mortality, and economic burden on our healthcare system, while exacerbations continue to be among the top 10 causes of hospitalization in adults. Previous literature has demonstrated that only 66% of patients receive "recommended" care during an acute exacerbation of COPD. The objective of this study was to evaluate adherence to GOLD guidelines for treatment of severe, non-life threatening COPD exacerbations at a university teaching hospital.
METHODS: This study was a retrospective chart review of all patients admitted from January 2007 to June 2008 with a primary diagnosis of severe, non-life threatening COPD exacerbation (ICD 9 code 491.21). Each patient's COPD treatment regimen was assessed and compared to GOLD guideline recommendations.
RESULTS: Two hundred fifty-nine patients met inclusion criteria. The majority of patients were African-American (73.7%) and female (60.6%), with a mean age of 69 years.. GOLD guidelines were met in 212 patients (81.9%). Length of stay was numerically higher in our patients versus the national average, 5.3 vs. 4.8 days (p=NS), respectively. Approximately 66% of the patients in our study received antibiotics with 71% being unwarranted per GOLD guidelines. Systemic corticosteroids were not administered to 11% of patients.
CONCLUSION: The potential to improve patient care through adherence to GOLD guidelines exists as evidenced by 18% of patients not receiving therapy per GOLD recommendations, including the administration of unnecessary antibiotics. In addition, systemic corticosteroids were not prescribed in all patients with a non-life threatening COPD exacerbation.
CLINICAL IMPLICATIONS: The management of non-life threatening COPD exacerbations in hospitalized patients needs improvement and should be in accordance with well-accepted international guidelines. Efforts should be undertaken to develop a treatment algorithm or protocol to be initiated upon admission to the hospital for such an exacerbation to optimize therapy and patient outcomes, while potentially reducing hospital length of stay.
DISCLOSURE: Andrew Woods, No Financial Disclosure Information; No Product/Research Disclosure Information