title: Variations in the management of acute exacerbations of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a significant cause of morbidity and mortality for patients with COPD. AECOPD are the leading cause of hospital admissions in Canada. Although multiple guidelines have been developed for the acute and chronic management of COPD, there are few quality assurance studies investigating adherence to these guidelines.
  
  
  METHODS
  A retrospective chart review of all patients admitted to a tertiary care hospital in 2009 for an AECOPD was performed. Using a standardized data abstraction tool, adherence to current guidelines across different physician groups and patient outcomes were assessed. Particular focus was centred on differences in management across physician groups.
  
  
  RESULTS
  Overall, 293 patients were evaluated. Of these, 82.6% were treated with one or more chronic COPD medication(s) in the community, with only 17.7% of patients treated with a long-acting inhaled anticholinergic medication. For treatment of AECOPD, 58% of patients received corticosteroids and 84% received antibiotics. Compared with general medicine and the hospitalist service, the respiratory medicine service demonstrated significantly better adherence with current treatment guidelines; however, even this was less than optimal. In addition, there was poor follow-up of patients cared for outside of the respiratory service.
  
  
  CONCLUSIONS
  The present study identified significant care gaps in the treatment of patients admitted with AECOPD and on their discharge.
authors.affiliation: Department of Medicine and Emergency Medicine, University of British Columbia, Vancouver, British Columbia V5Z 1M9. supna.s@gmail.com
authors.forename: Supna K
authors.initials: SK
authors.lastname: Sandhu
authors.forename: Jackson
authors.initials: J
authors.lastname: Chu
authors.forename: Marko
authors.initials: M
authors.lastname: Yurkovich
authors.forename: David
authors.initials: D
authors.lastname: Harriman
authors.forename: Catalin
authors.initials: C
authors.lastname: Taraboanta
authors.forename: J Mark
authors.initials: JM
authors.lastname: Fitzgerald
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D002908:Chronic Disease; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones