Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub‐optimal

Abstract

Background Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED). Guidelines recommend administration of inhaled bronchodilators, systemic corticosteroids and antibiotics along with non‐invasive ventilation (NIV) for patients with respiratory acidosis. Aim To determine compliance with guideline recommendations for patients treated for COPD in ED in Europe (EUR) and South East Asia/Australasia (SEA) and to compare management and outcomes. Methods In each region, an observational prospective cohort study was performed that included patients presenting to ED with the main complaint of dyspnoea during three 72‐h periods. This planned sub‐study included those with an ED primary discharge diagnosis of COPD. Data were collected on demographics, clinical features, treatment, disposition and in‐hospital mortality. We determined overall compliance with guideline recommendations and compared treatments and outcome between regions. Results A total of 801 patients was included from 122 ED (66 EUR and 46 SEA). Inhaled bronchodilators were administered to 80.3% of patients, systemic corticosteroids to 59.5%, antibiotics to 44 and 60.6% of patients with pH <7.3 received NIV. The proportion administered systemic corticosteroids was higher in SEA (EUR vs SEA for all comparisons; 52 vs 66%, P < 0.001) as was administration of antibiotics (40 vs 49%, P = 0.02). Rates of NIV and mechanical ventilation were similar. Overall in‐hospital mortality was 4.2% (SEA 3.9% vs EUR 4.5%, P = 0.77). Conclusion Compliance with guideline recommended treatments, in particular administration of corticosteroids and NIV, was sub‐optimal in both regions. Improved compliance has the potential to improve patient outcome.

Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol

“… 8 A planned substudy of AANZDEM concluded compliance with COPD evidence-based guidelines is suboptimal in EDs and suggested further research is required to improve compliance with care based on published guidelines. 18 …”

“… 26 Exploring the barriers and enablers for interdisciplinary team members to provide holistic care as per COPD guidelines (medical, physical, psychological, social, spiritual and palliation) is crucial. 18 27 Interdisciplinary care has proven to significantly optimise functionality and prevent deterioration in patients with COPD, which subsequently reduces hospital admissions and hospital days per person. 16 21 Initiation of consistent interdisciplinary healthcare interventions for patients with COPD will extrude any implementation gap and prevent readmissions.…”

“…8 A planned substudy of AANZDEM concluded compliance with COPD evidence-based guidelines is suboptimal in EDs and suggested further research is required to improve compliance with care based on published guidelines. 18 COPD exacerbations and their management were explored in an Ireland hospital through a prospective before and after study. Following the education of staff and the implementation of a COPD care bundle, the outcome for 51 consecutive patients was analysed.…”

Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review

“…8,9 COPD guidelines non-adherence in both pharmacological and non-pharmacological management is well-recognised and is a reported phenomenon in national and international literature. [10][11][12] A COCHRANE systematic review on integrated disease management programs for COPD reported improved disease-related quality of life, increased exercise capacity, reduced hospital admissions and hospital days per person. 13 Sub-optimal dissemination and implementation impede adoption into clinical practice by interdisciplinary health professionals.…”

“…16,17 However, worldwide research reports lack of COPD guideline adherence. 11,[18][19][20][21][22] Implications of guidelines non concordanceare repetitive readmissions with COPD exacerbations, increased economic burden, and poor optimisation of lung function and overall health. 12,23,24 This systematic review set out to identify known contributing factors towards COPD guidelines nonadherence from the time of admission to hospital to time of discharge.…”