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The European Respiratory Society COPD audit was an initiative to gain a better understanding of the service organizational factors in European hospitals that promote better outcomes, and to develop a core data set that can be used for future audits of COPD admissions with a view to raising the standard of care across Europe. During January and February 2011, demographic and clinical data on patients admitted to 11 Irish hospitals with COPD exacerbations were gathered. Patients were contacted again after a 90-day follow-up period to determine the clinical outcome. Completed data was gathered on 237 patients (114 Female, 123 Male), mean age 70.0 years (95%CI 68.6 to 71.5), and the mean smoking history was 51 pack/years (95%CI 74 to 55). 54 (22.8%) patients required ventilatory support (50 non-invasive, 4 invasive). Mean length of stay was 10.4 days (95%CI 9.1 to 11.7), and the readmission rate during the 90-day follow up was 40.1%. 211 patients (89%) were alive at 90-day follow-up. Final publication of the Europe-wide data is expected in late 2011 and is anticipated to provide valuable information of the strengths and weaknesses of COPD patient care with a view to directing future guidelines and healthcare provision throughout the continent. This abstract is funded by: None Am J Respir Crit Care Med 185;2012:A2313 Internet address: www.atsjournals.org Online Abstracts Issue

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Background: The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community-dwelling adults. Methods: Systematic review reported in line with the PRISMA guidelines and pre-registered with PROSPERO. Electronic databases (Medline (Ovid), EMBASE, PsycINFO, CINAHL, Cochrane Library) and grey literature sources were searched. Inclusion criteria: Community-dwelling adults; Risk-prescription medication; Outcomes-initiation of new medicine to ‘treat’ or reduce ADR risk; Study type-cohort, cross-sectional, case-control and case-series studies. Title/abstract screening, full-text screening, data extraction and methodological quality assessment was conducted independently in duplicate. A narrative synthesis was conducted. Results: A total of 101 studies (reported in 103 publications) were included. Study sample sizes ranged from 126 to 11,593,989 participants and 15 studies examined older adults specifically (≥60 years). Seventy-eight of 101 studies reported a potential prescribing cascade including calcium channel blockers to loop diuretic (n=5), amiodarone to levothyroxine (n=5), inhaled corticosteroid to topical antifungal (n=4), antipsychotic to anti-Parkinson drug (n=4), and acetylcholinesterase inhibitor to urinary incontinence drugs (n=4). Identified prescribing cascades occurred within three months to one year following initial medication. Methodological quality varied across included studies. Conclusion and implications: Prescribing cascades occur for a broad range of medications. ADRs should be included in the differential diagnosis for patients presenting with new symptoms, particularly older adults and those who started a new medication in the preceding 12 months. Word count: 245