title: Management of COPD exacerbations in primary care: a clinical cohort study.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) exacerbations are associated with lung function decline, lower quality of life, and increased mortality, and can be prevented by pharmacological treatment and rehabilitation.
  
  
  OBJECTIVE
  To examine management including examination, treatment, and planned follow-up of COPD exacerbation visits in primary care patients and to explore how measures and management at exacerbation visits are related to subsequent exacerbation risk.
  
  
  METHODS
  A clinical population of 775 COPD patients was randomly selected from 56 Swedish primary healthcare centres. Data on patient characteristics and management of COPD exacerbations were obtained from medical record review and a patient questionnaire. In the study population of 458 patients with at least one exacerbation, Cox regression analyses estimated the risk of a subsequent exacerbation with adjustment for age and sex.
  
  
  RESULTS
  During a follow-up period of 22 months, 238 patients (52%) had a second exacerbation. A considerable proportion of the patients were not examined and treated as recommended by guidelines. Patients with a scheduled extra visit to an asthma/COPD nurse following an exacerbation had a decreased risk of further exacerbations compared with patients with no extra follow-up other than regularly scheduled visits (adjusted hazard ratio 0.60 (95% confidence interval 0.37 to 0.99), p=0.045).
  
  
  CONCLUSIONS
  Guidelines for examination and emergency treatment at COPD exacerbation visits are not well implemented. Scheduling an extra visit to an asthma/COPD nurse following a COPD exacerbation may be associated with a decreased risk of further exacerbations in primary care patients.
authors.affiliation: Department of Respiratory Medicine, Örebro University Hospital & School of Health and Medical Science, Örebro University, 701 85 Örebro, Sweden.
authors.forename: Josefin
authors.initials: J
authors.lastname: Sundh
authors.forename: Eva
authors.initials: E
authors.lastname: Österlund Efraimsson
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
authors.forename: Scott
authors.initials: S
authors.lastname: Montgomery
authors.forename: Björn
authors.initials: B
authors.lastname: Ställberg
authors.forename: Karin
authors.initials: K
authors.lastname: Lisspers
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000359:Aftercare / Q000379:methods; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001314:Auscultation / Q000706:statistics & numerical data; D001784:Blood Gas Analysis / Q000706:statistics & numerical data; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D019468:Disease Management; D018450:Disease Progression; D004638:Emergency Treatment; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000706:statistics & numerical data; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000451:nursing / Q000628:therapy*; D011859:Radiography; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013548:Sweden
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents