Standardisation of Clinical Assessment, Management and Follow-Up of Acute Hospitalised Exacerbation of COPD: A Europe-Wide Consensus

Abstract

Background

Despite hospitalization for exacerbation being a high-risk event for morbidity and mortality, there is little consensus globally regarding the assessment and management of hospitalised exacerbations of COPD. We aimed to establish a consensus list of symptoms, physiological measures, clinical scores, patient questionnaires and investigations to be obtained at time of hospitalised COPD exacerbation and follow-up.

Methods

A modified Delphi online survey with pre-defined consensus of importance, feasibility and frequency of measures at hospitalisation and follow-up of a COPD exacerbation was undertaken.

Findings

A total of 25 COPD experts from 18 countries contributed to all 3 rounds of the survey. Experts agreed that a detailed history and examination were needed. Experts also agreed on which treatments are needed and how soon these should be delivered. Experts recommended that a full blood count, renal function, C-reactive protein and cardiac blood biomarkers (BNP and troponin) should be measured within 4 hours of admission and that the modified Medical Research Council dyspnoea scale (mMRC) and COPD assessment test (CAT) should be performed at time of exacerbation and follow-up. Experts encouraged COPD clinicians to strongly consider discussing palliative care, if indicated, at time of hospitalisation.

Interpretation

This Europe-wide consensus document is the first attempt to standardise the assessment and care of patients hospitalised for COPD exacerbations. This should be regarded as the starting point to build knowledge and evidence on patients hospitalised for COPD exacerbations.

Keywords:

• COPD
• disease exacerbation
• hospitalisation
• patient care
• consensus development
• expert opinion

Acknowledgments

We are very grateful to all the experts who contributed generously to this project, including Alan Altraja; Giovanna Elisiana Carpagnano; Joanna Chorostowska-Wynimko; Christian Clarenbach; Aikaterini Dimakou; Marta Drummond; Aleksandra Dudvarski Ilic; Matjaz Flezar; Ana Hećimović; Hannu Kankaanranta; Huib Kerstjens; Nurdan Köktürk; Jose Luis Lopez-Campos Bodineau; Eric Van Ganse. We also thank Ms Alessandra Marguerat and Dr Elise Heuvelin at the European Respiratory Society for their technical and programming support.

Sanjay Ramakrishnan was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author and not necessarily those of the National Health Service, the NIHR or the Department of Health.

Disclosure

Dr. Ramakrishnan reports non-financial support from AstraZeneca, PhD scholarship from Australian Government Research Training Program (RTP) and junior researcher salary support from National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), during the conduct of the study and outside the submitted work.

Dr. Janssens reports grants from Chiesi, AstraZeneca and GSK, advisory board membership for Boerhinger Ingelheim, AstraZeneca, Chiesi, GSK outside the submitted work; and W. Janssens is cofounder of ARTIQ, a spinoff company of KULEUVEN.

Dr. Burgel reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis, Pfizer, Insmed and Zambon, and grants and personal fees from GSK and Vertex, outside the submitted work.

Dr. Contoli reports grants and personal fees from Chiesi, AstraZeneca and GlaxoSmithKline, personal fees from Boehringer Ingelheim, Alk-Abello, Novartis and Zambon and grants from University of Ferrara, Italy, outside the submitted work.

Dr. Franssen reports grants and personal fees from AstraZeneca and Novartis, and personal fees from Boehringer Ingelheim, Chiesi, GlaxoSmithKline and TEVA, outside the submitted work.

Dr. Greening reports grants and personal fees from GSK, personal fees and non-financial support from Chiesi, and Boehringer Ingelheim outside the submitted work.

Dr. Greulich reports personal fees from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, GSK, Novartis, grants from German Centre for Lung Research (DZL), Marburg, Germany (Deutsches Zentrum für Lungenforschung), grants and personal fees from Grifols and CSL-Behring and lectures and advisory boards for GSK, Novartis and Roche, outside the submitted work.

Dr. Gyselinck reports other non financial support from KU-Leuven, outside the submitted work.

Dr. Quint reports grants from MRC, during the conduct of the study; personal fees from GSK, grants from Asthma UK, Chiesi, MRC and The Health Foundation, grants and personal fees from AZ and BI, Bayer outside the submitted work.

Dr. Vanfleteren reports grants and personal fees from AstraZeneca, personal fees from Novartis, GSK, Chiesi, Menarini, Pulmonx, Resmed, Boehringer, Verona Pharma and AGA Linde outside the submitted work.

Dr. Bafadhel reports grants and personal fees from AstraZeneca, personal fees from Chiesi and GSK, grants and non-financial support from AZ, non-financial support from Chiesi and GSK and advisory board membership for Albus Health and ProAxsis, outside the submitted work.

The authors report no other potential conflicts of interest for this work.