Emergency department management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: the Multicenter Airway Research Collaboration.
OBJECTIVE
To determine adherence of emergency department (ED) management of acute exacerbation of chronic obstructive pulmonary disease (COPD) to current treatment guidelines.


METHODS
A prospective cohort study, as part of the Multicenter Airway Research Collaboration.


METHODS
The study was performed at 29 EDs in 15 U.S. states and three Canadian provinces.


METHODS
ED patients, aged 55 and older, who presented with COPD exacerbation and underwent a structured interview in the ED and another by telephone 2 weeks later.


METHODS
Adherence of ED management of COPD exacerbation to that recommended in current treatment guidelines.


RESULTS
The cohort consisted of 397 subjects, of whom 224 (56%) reported only COPD and 173 (44%) reported asthma and COPD. The average age was 70. Most (80%) patients had used rescue medications in the 6 hours before seeking emergency care. Only 31% were evaluated using spirometry and 48% using arterial blood gas measurement. ED treatment included inhaled short-acting beta-agonists for 91% of patients, inhaled anticholinergics for 77%, methylxanthines for 0.3%, systemic corticosteroids for 62%, and antibiotics for 28%. More than half the patients required hospitalization. At 2-week follow-up, 43% of patients reported a relapse event or ongoing exacerbation. Overall, adherence to national and international guidelines was low.


CONCLUSIONS
Important differences exist between guideline recommendations and actual ED management of COPD exacerbations in older adults. Outcomes after ED treatment are poor and may be related to these shortcomings in quality of care. Better adherence to guideline recommendations when caring for elderly patients with COPD exacerbations may lead to improved clinical outcomes and better resource usage.
Cydulka
Rita K
RK
MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. rcydulka@metrohealth.org
Rowe
Brian H
BH
Clark
Sunday
S
Emerman
Charles L
CL
Camargo
Carlos A
CA
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000402:Airway Obstruction / Q000628:therapy*; D015331:Cohort Studies; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*