Inhospital management of COPD exacerbations: a systematic review of the literature with regard to adherence to international guidelines

Abstract

Rationale Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of hospitalization. Suboptimal inhospital management is expected to lead to more frequent exacerbations and recurrent hospital admission, and is associated with increased mortality. Aims To explore inhospital management of COPD and to compare the results with recommendations from international guidelines. Methods A literature search was carried out for relevant articles published 2000-2009 in the databases Medline, Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and Invert. In addition, the reference lists of the selected articles were examined. Main inclusion criteria were as follows: COPD, exacerbation, hospitalization, description of inpatient management, and clinical trials. Assessment and treatment strategies in different studies were analysed and compared with American Thoracic Society-European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease guidelines. Outcomes were analysed. Results Seven eligible studies were selected. Non-pharmacological treatment was infrequently explored. When compared with international guidelines, diagnostic assessment and therapy were suboptimal, especially non-pharmacological treatment. Respiratory physicians were more likely to perform recommended interventions than non-respiratory physicians. Conclusions Adherence to international guidelines is low for inhospital management of COPD exacerbations, especially in terms of non-pharmacological treatment. Further investigation is recommended to explore strategies like care pathways that improve performance of recommended interventions.

Integrated Care: What does this Mean for the COPD Patient?

“…On a patient level, health-related quality of life remains substantially impaired across all spirometric stages, adherence across multiple aspects of therapy (including smoking cessation, physical exercise and activity, and maintenance medications) remains disappointingly low [1], and only about 40% become successful self-managers despite educational efforts [2,3]. On a health care provider level, comorbidities -which often contribute substantially to total disease burden [4] -are frequently underestimated or even ignored [5], adherence to practice guidelines for COPD is suboptimal [6,7], and referral to standard-of-care pulmonary rehabilitation is unacceptably low [1]. On a system level, COPD remains a leading cause of mortality, and health care utilization, as reflected by a 30-day hospital readmission rate hovering around 20% [8][9][10], remains unacceptably high.…”

What Is the Role of PFTs in Monitoring Adverse Effects of Surgery, Drug Treatments, Radiation Therapy, and During Hospitalization?

“…A systematic review of literature addressing adherence to the GOLD guidelines, by Lodewijckx and colleagues, found that spirometry was performed in only 12% to 18% of COPD patients hospitalized with COPD exacerbations. 22 It would appear that clinicians have either not read the guidelines, are following the ATS/ERS recommendations, or are skeptical of the value of spirometry in these patients altogether.…”

Effect of a Cognitive Aid on Adherence to Perioperative Assessment and Management Guidelines for the Cardiac Evaluation of Noncardiac Surgical Patients

“…4,5 DSTs often improve adherence to published guidelines and in many instances improve clinical outcomes, although this has not been universally true. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] However, most research on clinical decision support has focused upon patient management after initial assessment and diagnosis or through mandatory alerts for providers, such as reminders for intraoperative antibiotic prophylaxis, postoperative nausea and vomiting prophylaxis, or proper use of alarms for separate from cardiopulmonary bypass. [26][27][28][29][30][31][32][33][34] In contrast, the use of DSTs for patient assessment/diagnosis and the subsequent application of evidence-based protocols has yet to be rigorously tested.…”