title: Management of acute exacerbation of COPD in rural Alberta emergency departments.
abstract: BACKGROUND
  Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a common presentation to emergency departments (EDs); however, limited information exists about the management of this condition in nonurban locations. We sought to examine the diagnostic and treatment approaches for acute exacerbation of COPD in 3 rural EDs, and to determine levels of adherence to recommendations from the Canadian Thoracic Society (CTS) clinical practice guideline.
  
  
  METHODS
  We conducted retrospective chart reviews to explore the management of patients who presented to 3 rural EDs for acute exacerbation of COPD in 2011. Data are reported as medians and interquartile ranges (IQRs) and proportions.
  
  
  RESULTS
  Over a 1-year period, 192 patients presented a total of 266 times with acute exacerbation of COPD. The median age was 68 (IQR 58-77) years, and 54.9% of the patients were women. Diagnostic testing included chest radiography in 65.0%, blood tests in 45.1%, electrocardiography in 33.5%, and arterial blood gas tests in 6.4%; only a few patients received pulmonary function testing. In the ED, 58.7% of patients were given a short-acting β-agonist, 48.9% a short-acting anticholinergic, 27.4% corticosteroids and 19.9% antibiotics. Overall, short-acting β-agonists (63.5%), anticholinergic agents (53.4%), corticosteroids (54.5%) and antibiotics (71.1%) were prescribed more commonly to discharged patients (p < 0.05 for all).
  
  
  CONCLUSIONS
  We found a low to moderate level of adherence to the CTS clinical practice guideline for the management of acute exacerbation of COPD in these rural EDs. Moreover, we identified gaps in both diagnostic and therapeutic care.
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
authors.forename: Paul
authors.initials: P
authors.lastname: McKenna
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
authors.forename: Kelsey
authors.initials: K
authors.lastname: MacLeod
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
authors.forename: Christopher
authors.initials: C
authors.lastname: Le
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
authors.forename: Kevin
authors.initials: K
authors.lastname: Tok
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
authors.forename: Jessie
authors.initials: J
authors.lastname: Ursenbach
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Sutherland
authors.affiliation: Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alta.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Gaudet
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Couperthwaite
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, Alta.
authors.forename: Cristina
authors.initials: C
authors.lastname: Villa-Roel
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine and Dentistry, and School of Public Health, University of Alberta, Edmonton, Alta.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000208:Acute Disease; D000416:Alberta; D003131:Combined Modality Therapy; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D019983:Guideline Adherence; D006302:Health Services Research / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy*; D019035:Rural Health Services / Q000458:organization & administration*