PURPOSE: COPD exacerbation is defined as a sustained worsening from the stable state and beyond normal day-to-day variations, that is acute in onset and sufficient to warrant additional treatment. Treatment of COPD exacerbation should include bronchodilators and systemic corticosteroids. The purpose of our study was to determine the use of systemic corticosteroids and inhaled bronchodilators for the treatment of COPD exacerbations at a community-based tertiary care center.
METHODS: Retrospective chart review was conducted of COPD exacerbations between July 1, 2004 and June 30, 2005. Patients were identified using ICD-9 codes for COPD as the primary admitting diagnosis. The number of patients discharged with a prescription for systemic corticosteroids and bronchodilators was tabulated. Patients were included whether admitted or discharged from the ED.
RESULTS: We identified 383 patients with COPD exacerbation. A total of 218 (57%) patients were discharged from the emergency department, and 165 (43%) were admitted. Three-hundered and two patients (78.9%) were prescribed systemic corticosteroids at discharge and 356 patients (92.9%) were prescribed bronchodilators at discharge. Of the 218 patients discharged from the ED, 160 (73.4%) were prescribed systemic corticosteroids and 195 (89.5%) bronchodilators. Of the 165 admitted patients, 142 (86.1%) were prescribed corticosteroids and 161 (97.6%) bronchodilators at discharge.
CONCLUSION: In this study, 78.9% of patients diagnosed with COPD exacerbation received systemic corticosteroids and 92.9% were prescribed bronchodilators. Compliance with treatment guidelines was more common in patients admitted to the hospital than those discharged from the ED.
CLINICAL IMPLICATIONS: COPD exacerbation causes significant morbidity, resulting in one million emergency room visits annually. One-third of patients discharged will experience recurrent symptoms, often requiring hospital admission. Previously published data suggests systemic corticosteroids are appropriately prescribed in less than 50% of exacerbations. While our compliance with established guidelines was higher than published data, greater adherence to guidelines might prevent hospitalizations and reduce morbidity associated with the disease.
DISCLOSURE: Scott Morin, No Financial Disclosure Information; No Product/Research Disclosure Information