Analysis of hospitalizations for COPD exacerbation: opportunities for improving care.
BACKGROUND
Little is known about the actual treatment of patients with chronic obstructive pulmonary disease (COPD), either in the inpatient or outpatient settings. We hypothesized that there are substantial opportunities for improvement in adherence with current guidelines and recommendations.


METHODS
We reviewed the medical records of all patients hospitalized with acute exacerbation of COPD between January 2005 and December 2006 at 5 New York City hospitals.


RESULTS
There were 1285 unique patients with 1653 hospitalizations. Of these 1653, 83% were for patients with a prior history of COPD and 368 (22%) represented repeat admissions during our study period. The majority were treated during their hospitalization with a combination of systemic steroids (85%), bronchodilators (94%) and antibiotics (80%). There were 59 deaths (3.6%). Smoking cessation counseling was offered to 48% of active smokers. Influenza and pneumococcal vaccines were administered to half of eligible patients. On discharge, only 46.0% were prescribed maintenance bronchodilators and 24% were not prescribed any inhaled therapy. Even in the 226 unique patients (17.6%) readmitted at least once during course of the study, on discharge only 44.7% were prescribed maintenance bronchodilators and 23% were not prescribed any regular inhaled therapy.


CONCLUSIONS
Patients hospitalized with acute exacerbation of COPD generally receive adequate hospital care, but there may be opportunities to improve care pharmacologically and with smoking cessation counseling and vaccination during and after hospitalization.
Yip
Natalie H
NH
Division of Pulmonary, Allergy and Critical Care, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA. nhy1@columbia.edu
Yuen
George
G
Lazar
Eliot J
EJ
Regan
Brian K
BK
Brinson
Marcia D
MD
Taylor
Brian
B
George
Liziamma
L
Karbowitz
Stephen R
SR
Stumacher
Richard
R
Schluger
Neil W
NW
Thomashow
Byron M
BM
D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009519:New York City; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies; D016540:Smoking Cessation
D001993:Bronchodilator Agents; D005938:Glucocorticoids; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines