RESULTS: From 8/2014 to 7/2015, 388 patients were cared for in the pulmonary clinic and 38/388 (9.8 %) utilized the ED two or more times. The characteristics of the frequent utilizers revealed a mean age of 68.3 ± 14.4 with a female predominance (58 %) and majority were Caucasian (68 %). Mean FEV1 was 1.40 ± 0.63 L. Twenty nine patients (76 %) were noted to be living with a spouse or family. Insurance status included Medicare (53%), Medicaid (18 %) and dual eligible (11 %). Former smokers were noted in 74 % of the group. Cardiovascular conditions included heart failure with preserved ejection fraction (76 %), heart failure with reduced ejection fraction (24 %) and hypertension (71 %). Sleep disordered breathing was recognized in 29%. Psychiatric disorders including bipolar disorder, schizophrenia and anxiety was noted in 40% of the cohort. Long term oxygen therapy was prescribed to 53 % of patients. The majority were prescribed a short and long acting beta agonist (Table 1). ED visits related to COPD were noted in 24 patients (63 %) with long term oxygen treatment prescribed to 16/24 (67 %). In patients with a COPD related ED visit, heart failure with preserved ejection fraction was observed in 92 % and sleep disordered breathing in 38 %.