Improved care of acute exacerbation of chronic obstructive pulmonary disease in two academic emergency departments
Although several chronic obstructive pulmonary disease (COPD) practice guidelines have been published, there is sparse data on the actual emergency department (ED) management of acute exacerbation of COPD (AECOPD).
Our objectives were to examine concordance of ED care of AECOPD in older patients with guideline recommendations and to evaluate whether concordance has improved over time in two academic EDs.
Data were obtained from two cohort studies on AECOPD performed in two academic EDs during two different time periods, 2000 and 2005–2006. Both studies included ED patients, aged 55 and older, who presented with AECOPD, and cases were confirmed by emergency physicians. Data on ED management and disposition were obtained from chart review for both cohorts.
The analysis included 272 patients: 72 in the 2000 database and 200 in the 2005–2006 database. The mean age of the patients was 72 years; 50% were women and 80% white. In 2005–2006, overall concordance with guideline recommendations was high (for chest radiography, pulse oximetry, bronchodilators, all ≥ 90%), except for arterial blood gas testing (7% among the admitted) and discharge medication with systemic corticosteroids (42%). Compared to the 2000 data, the use of systemic corticosteroids in the ED improved from 53 to 77% [absolute improvement: 24%, 95% confidence interval (CI): 11–37%], and the use of antibiotics among the patients with respiratory infection symptoms improved from 56 to 78% (absolute improvement: 22%, 95% CI: 6–38%).
Overall concordance with guideline-recommended care for AECOPD was high in two academic EDs, and some emergency treatments have improved over time.
- Tsai CL, Sobrino JA, Camargo CA Jr (2008) National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993–2005. Acad Emerg Med 15:1275–1283 CrossRef
- Cydulka RK, Rowe BH, Clark S, Emerman CL, Camargo CA Jr (2003) Emergency department management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: the Multicenter Airway Research Collaboration. J Am Geriatr Soc 51(7):908–916 CrossRef
- Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee (2001) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 163(5):1256–1276
- Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2007). NHLBI/WHO Global Strategy for the Diagnosis, Management and Prevention of COPD. Available via: http://www.goldcopd.org.
- Bach PB, Brown C, Gelfand SE, McCrory DC, American College of Physicians-American Society of Internal Medicine, American College of Chest Physicians (2001) Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern Med 134(7):600–620
- Celli BR, MacNee W, ATS/ERS Task Force (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 23(6):932–946 CrossRef
- Ginde AA, Tsai CL, Blanc P, Camargo CA Jr (2008) Positive predictive value of ICD-9-CM codes to detect acute exacerbation of COPD in the emergency department. Jt Comm J Qual Patient Saf 34:678–680
- National Committee on Quality Assurance (2008) The Health Care Effectiveness Data and Information Sets (HEDIS), 2008 Quality Measures for Pharmacotherapy of COPD Exacerbation. Available via: http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2008/2008_Measures.pdf. Accessed July 10
- Rodriguez-Roisin R (2000) Toward a consensus definition for COPD exacerbations. Chest 117(5 Suppl 2):398S–401S CrossRef
- Smithline HA, Rowe BH, Radeos MS, Cydulka RK, Camargo CA Jr, Working Group on Emergency Management of COPD Exacerbations (2005) Research opportunities in the management of acute exacerbations of chronic obstructive pulmonary disease. Acad Emerg Med 12(8):742–750 CrossRef
- McDermott MF, Lenhardt RO, Catrambone CD, Walter J, Weiss KB (2006) Adequacy of medical chart review to characterize emergency care for asthma: findings from the Illinois Emergency Department Asthma Collaborative. Acad Emerg Med 13(3):345–348 CrossRef
- Improved care of acute exacerbation of chronic obstructive pulmonary disease in two academic emergency departments
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
International Journal of Emergency Medicine
Volume 2, Issue 2 , pp 111-116
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Chronic obstructive pulmonary disease
- Quality of care
- Author Affiliations
- 1. EMNet Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 326 Cambridge St, Suite 410, Boston, MA, 02114, USA
- 2. Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA