High prevalence of undiagnosed and severe chronic obstructive pulmonary disease at first hospital admission with acute exacerbation

Abstract

Chronic obstructive pulmonary disease (COPD) is a common cause of acute medical hospital admission, and the prevalence of undiagnosed COPD in the community is high. The impact of undiagnosed COPD on presentation to secondary care services is not currently known. We therefore set out to characterise patients at first admission with an acute exacerbation of COPD, and to identify potential areas for improvement in earlier diagnosis and further management. A retrospective case review of patients first admitted to a district teaching hospital with an acute exacerbation of COPD over a 1-year period was carried out. Forty-one patients with a first admission with an acute exacerbation of COPD were identified, 14 (34%) of whom had not been previously diagnosed and were diagnosed with COPD as a result of the admission. At presentation, this group of patients had severe disease, with mean (SD) FEV(1) 1.02 (0.32) L, and a respiratory acidosis in eight (20%) patients, even though this was their first admission for an acute exacerbation of COPD. Missed potential opportunities to intervene in community and inpatient management were identified, including earlier diagnosis, pre-hospital corticosteroid therapy, inpatient respiratory team input, provision of smoking cessation advice and consideration of pulmonary rehabilitation. Patients with a first hospital admission with an acute exacerbation of COPD frequently have severe disease at presentation. Despite having severe disease, a diagnosis of COPD had not been made in the community prior to admission in one-third of patients. Future work should be directed at earlier identification of patients who are symptomatic from COPD and ensuring that the interventions of proven benefit in COPD are systematically offered to patients in both primary and secondary care.

Trends in the lifetime risk of COPD exacerbation requiring hospitalisation

“…The few previous COPD lifetime risk studies [6][7][8] have not focused on the risk of developing the end stages of COPD, in which mortality, quality of life reduction and healthcare costs are highest, and hospitalisations with exacerbation of the disease are frequent [9][10][11][12].…”

Advance care planning in chronic obstructive pulmonary disease: barriers and opportunities

“…Many primary care physicians have a limited understanding of COPD and fail to diagnose the disease with onset of early symptoms, with many patients remaining undiagnosed until hospitalization for an acute exacerbation of severe disease [26]. Patients often fail to report or recognize milder exacerbations and attribute symptoms to 'chest colds,' which further delays diagnosis and ACP.…”

Advances in the Outpatient Management of Chronic Obstructive Pulmonary Disease

“…3 Perhaps still more disturbing, it is estimated that half of all patients with COPD are unaware of their diagnosis, 4 including patients with more severe disease and those hospitalized for acute exacerbations. 5,6 This is a multidimensional problem; patients may minimize chronic symptoms or wish to avoid conversations revolving around tobacco use and cessation; physicians may misclassify symptoms as acute illnesses or attribute them to another underlying disease process. Spirometry still remains underutilized as a screening tool, and many patients are not diagnosed until disease is quite advanced.…”