Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub‐optimal. Issue 2 (9th February 2020)

• Record Type: Journal Article
• Authors: Kelly, Anne‐Maree; Van Meer, Oene; Keijzers, Gerben; Motiejunaite, Justina; Jones, Peter; Body, Richard; Craig, Simon; Karamercan, Mehmet; Klim, Sharon; Harjola, Veli‐Pekka; Verschuren, Franck; Holdgate, Anna; Christ, Michael; Golea, Adela; Graham, Colin A.; Capsec, Jean; Barletta, Cinzia; Garcia‐Castrillo, Luis; Kuan, Win S.; Laribi, Said
• Other Names: McNulty Richard investigator.; Tan Clifford investigator.; Cowell David Lord investigator.; Holdgate Anna investigator.; Jain Nitin investigator.; Devillecourt Tracey investigator.; Forrester Alan investigator.; Lee Kendall investigator.; Chalkley Dane investigator.; Gillett Mark investigator.; Lozzi Lydia investigator.; Asha Stephen investigator.; Duffy Martin investigator.; Watkins Gina investigator.; Stone Richard investigator.; Rosengren David investigator.; Thone Jae investigator.; Martin Shane investigator.; Orda Ulrich investigator.; Thom Ogilvie investigator.; Kinnear Frances investigator.; Eley Rob investigator.; Ryan Alison investigator.; Morel Douglas investigator.; May Christopher investigator.; Furyk Jeremy investigator.; Thomson Graeme investigator.; Smith Simon investigator.; Smith Richard investigator.; Maclean Andrew investigator.; Grummisch Michelle investigator.; Meyer Alistair investigator.; Meek Robert investigator.; Rosengarten Pamela investigator.; Chan Barry investigator.; Haythorne Helen investigator.; Archer Peter investigator.; Craig Simon investigator.; Wilson Kathryn investigator.; Knott Jonathan investigator.; Ritchie Peter investigator.; Bryant Michael investigator.; MacDonald Stephen investigator.; Lee Tom investigator.; Mahlangu Mlungisi investigator.; Mountain David investigator.; Rogers Ian investigator.; Otto Tobias investigator.; Stuart Peter investigator.; Bament Jason investigator.; Brown Michelle investigator.; Jones Peter investigator.; Greven‐Garcia Renee investigator.; Scott Michael investigator.; Cheri Thomas investigator.; Nguyen Mai investigator.; Graham Colin investigator.; Wong Chi‐Pang investigator.; Wong Tai Wai investigator.; Leung Ling‐Pong investigator.; Man Chan Ka investigator.; Saiboon Ismail Mohd investigator.; Rahman Nik Hisamuddin investigator.; Lee Wee Yee investigator.; Lee Francis Chun Yue investigator.; Kuan Win Sen investigator.; Russell SharonKerrie investigator.; Kelly Anne‐Maree investigator.; Laribi Gerbenand Said investigator.; Lawoko Charles investigator.; Laribi Said investigator.; van Meer Oene investigator.; Body Richard investigator.; Karamercan Mehmet investigator.; Harjola Veli‐Pekka investigator.; Golea Adela investigator.; Verschuren Franck investigator.; Christ Michael investigator.; Barletta Cinzia investigator.; Garcia‐Castrillo Luis investigator.; Al Dandachi Ghanima investigator.; Maignan Maxime investigator.; Hermand DominiqueChristelle investigator.; Tessier Cindy investigator.; Roy Pierre‐Marie investigator.; Bucco Lucie investigator.; Duytsche Nicolas investigator.; Garmilla Pablo investigator.; Barletta Cinzia investigator.; Carbone Giorgio investigator.; Cosentini Roberto investigator.; Truță Sorana investigator.; Hrihorișan Natalia investigator.; Cimpoeșu Diana investigator.; Rotaru Luciana investigator.; Petrică Alina investigator.; Cojocaru Mariana investigator.; Nica Silvia investigator.; Tudoran Rodica investigator.; Vecerdi Cristina investigator.; Puticiu Monica investigator.; Schönberger Titus investigator.; Coolsma Constant investigator.; Baggelaar Maarten investigator.; Fransen Noortje investigator.; van den Brand Crispijn investigator.; Idzenga Doutsje investigator.; Maas Maaike investigator.; Franssen Myriam investigator.; Mackaij‐Staal Charlotte investigator.; Schutte Lot investigator.; de Kubber Marije investigator.; Mignot‐Evers Lisette investigator.; Penninga‐Puister Ursula investigator.; Jansen Joyce investigator.; Kuijten Jeroen investigator.; Bouwhuis Marna investigator.; Body Richard investigator.; Reuben Adam investigator.; Smith Jason investigator.; Ramlakhan Shammi investigator.; Darwent Melanie investigator.; Gagg James investigator.; Keating Liza investigator.; Bongale Santosh investigator.; Hardy Elaine investigator.; Keep Jeff investigator.; Jarman Heather investigator.; Crane Steven investigator.; Lawal Olakunle investigator.; Hassan Taj investigator.; Corfield Alasdair investigator.; Reed Matthew investigator.; Smolarsky Yvonne investigator.; Blaschke Sabine investigator.; Jerrentrup ClemensAndreas investigator.; Hohenstein Christian investigator.; Brünnler FelixTanja investigator.; Ghuysen Alexandre investigator.; Vranckx Marc investigator.; Verschuren Franck investigator.; Karamercan Mehmet A. investigator.; Ergin Mehmet investigator.; Dundar Zerrin D. investigator.; Altuncu Yusuf A. investigator.; Arziman Ibrahim investigator.; Avcil Mucahit investigator.; Katirci Yavuz investigator.; Kokkonen Liisa investigator.; Valli JukkaJuha investigator.; Kiljunen Minna investigator.; Tolonen Jukka investigator.; Kaye Sanna investigator.; Mäkelä JukkaMikko investigator.; Metsäniitty JukkaJuhani investigator.; Vaula Eija investigator.; Duytsche Nicolas investigator.; Garmilla Pablo investigator.;
• Is Part Of: Internal medicine journal. Volume 50:Issue 2(2020)
• Page Start: 200
• Page End: 208
• Publication Date: 2020-02-09
• Subjects: dyspnoea -- emergency department -- management -- COPD -- outcome; Medicine -- Periodicals; 616
• DOI: 10.1111/imj.14323
• Languages: English
• ISSNs: 1444-0903

Abstract

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.