Are We Missing the Opportunity to Disseminate GOLD Recommendations Through AECOPD Discharge Letters?

Figures & data

Table 1 Characteristics of the Study Population

Variables	Total (N=593)	ER Treated Group (N=368)	Hospitalized Group (N=225)
Female, n (%)	222 (37.4)	139 (37.8)	83 (36.9)
Mean age (SD), years	70.8 (9.1)	70.6 (9.3)	71.2 (8.9)
Duration of COPD (SD), years	8.8 (7.2)	8.1 (6.0)	9.9 (8.7)
Smoking status, n (%)
Active	199 (33.5)	117 (31.8)	82 (36.4)
Ex-smoker	223 (37.6)	136 (37.0)	87 (38.7)
Never smoker	71 (12.0)	44 (12.0)	27 (12.0)
Referral to ER, n (%)
Ambulance	163 (27.5)	61 (16.6)	102 (45.3)
GP	145 (24.5)	120 (32.6)	25 (11.1)
Pulmonologist	27 (4.6)	15 (4.1)	12 (5.3)
Own initiative	195 (32.9)	131 (35.6)	64 (28.4)

Abbreviations: COPD, chronic obstructive pulmonary disease; ER, emergency room; GP, general practitioner; SD, standard deviation.

Table 2 Specific Items of Interest Stated in Discharge Letters and Used to Assess the Adherence to the GOLD Recommendations. All Results are Expressed as Percentages (%)

Variables	Total (N=593)	ER Treated Group (N=368)	Hospitalized Group (N=225)
COPD severity
Severity of COPD (GOLD grades 1,2,3,4)	9.1	8.7	9.8
Category of COPD (GOLD A,B,C,D)	10.9	8.4	15.1
Severity of COPD in final discharge diagnosis	13.2	5.7	25.8
Severity of current AE as leading discharge diagnosis	7.3	1.4	16.9
Phenotypes
Phenotype of AE	44.5	33.7	62.2
Number of AEs in the previous year	34.4	31.5	39.1
Frequent exacerbator (FE) phenotype	0	0	0
Available data to determine FE phenotype	23.1	19.6	33.3
Blood Eos finding	61.3	54.6	72.4
Comment on Eos as decision-relevant information	1.5	0.5	3.1
Maintenance treatment
Change of previous maintenance therapy	39.4	27.9	58.4
No recommendation for maintenance therapy at discharge	18.2	25.0	7.2
Recommended change of the type of inhaler	21.6	15.5	31.6
Recommended education on the proper use of inhalers	6.4	4.3	15.6
Comment on adherence to regular inhalation therapy	20.7	23.4	16.4
Non-pharmacological treatment
Smoking cessation program advised	13.7	7.9	23.1
Pulmonary rehabilitation, advised/appointed	13.4/0.62	0.8/0	36.5/1.8
Early follow-up, advised/appointed	71.7/32.1	78.8/26.9	60.0/44.5

Abbreviations: AE, acute exacerbation; COPD, chronic obstructive pulmonary disease; Eos, eosinophils; FE, frequent exacerbator; GOLD, Global Initiative on COPD; ICS, inhaled corticosteroids.

Figure 1 Changes made at discharge in maintenance treatment recommendations. (A) Hospitalized patients; (B) patients discharged from emergency room.

Note: Patients who received LAMA + LABA/ICS or LABA/LAMA + ICS concomitantly were included in the triple therapy group.

Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting beta-agonists; LAMA, long-acting muscarinic agonists.