Current care services provided for patients with COPD in the Eastern province in Saudi Arabia: a descriptive study

Figures & data

Figure 1 The main areas in the Eastern province in Saudi Arabia.

Notes: Eastern province is divided in to three main areas: 1) Eastern area (Blue area), 2) Al-Ahsa area (Purple area), 3) Hafar Al-Batin area (Orange area).

Figure 2 Flow diagram of government hospital’s progress through the study.

Table 1 Summary of the current care provided by each hospital in the Eastern province

Area	Eastern area: n=14															Al-Ahsa area: n=5						Hafar Al-Batin area: n=3				Total (N; %)
Hospital information	Total (N)	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total (N)	O	P	Q	R	S	Total (N)	T	U	V
Number of beds	2,029	600	50	30	60	26	200	50	30	30	30	425	368	100	30	752	502	30	50	50	120	380	300	30	50	3,161
Emergency admissions for patients with COPD in 2012	902	200	50	0	10	10	10	0	0	100	2	200	100	200	20	210	50	50	0	50	60	92	52	0	40	1,204
Hospitals with respiratory department	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Hospitals with a specific respiratory outpatient clinic	2	1	0	0	0	0	0	0	0	0	0	1	0	0	0	1	1	0	0	0	0	0	0	0	0	3; 13.6
Hospitals providing spirometry	3	1	0	0	0	0	0	0	0	0	0	1	0	1	0	1	1	0	0	0	0	1	1	0	0	5; 22.7
Hospitals with ICU	5	1	0	0	0	0	1	0	0	0	0	1	1	1	0	2	1	0	0	0	1	1	1	0	0	8; 36.3
Hospitals offering invasive mechanical ventilation	9	1	1	0	1	0	1	0	0	1	0	1	1	1	1	2	1	0	0	0	1	1	1	0	0	12; 54.5
Hospitals offering noninvasive ventilation	6	1	0	0	0	0	1	0	0	0	0	1	1	1	1	0	0	0	0	0	0	1	1	0	0	7; 31.8
Hospitals having a pulmonary rehabilitation program and/or an early support discharge program	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0

Note: A to V refers to a different specific hospital.

Abbreviation: ICU, intensive care unit.

Table 2 Comparison between GOLD guideline recommendations and services available in hospitals in the Eastern province in Saudi Arabia

GOLD recommendations	Hospitals in the Eastern province (n=22)
Specialized care for respiratory diseases	No respiratory departments and only 13.6% of hospitals (n=3) have a specific respiratory outpatient clinic
Spirometry is required to make the diagnosis of COPD	Five hospitals (22.7%) have spirometry available
COPD assessment must consider the following aspects of the disease separately: current level of patient’s symptoms, severity of the spirometric abnormality, exacerbation risk, and presence of comorbidities	No information available
Pulmonary rehabilitation (PR) program and physical activity is recommended for all patients with COPD	No PR program and physical activity are offered to patients with COPD
Oxygen therapy is recommended for patients with chronic respiratory failure	Eight hospitals (36.6%) offer long-term oxygen therapy for patients with COPD
Noninvasive ventilation (NIV) has been shown to improve acute respiratory acidosis	Seven hospitals (31.8%) offer noninvasive ventilation
Invasive mechanical ventilation is need when patients unable to tolerate noninvasive mechanical ventilation (severe exacerbations)	Twelve hospitals (54.5%) offer invasive mechanical ventilation
Immediate admission to ICU when is needed	Eight hospitals (36.6%) have an ICU
Smoking cessation is the key intervention for all patients with COPD who continue to smoke	No information available
Pharmacologic therapy such as short-acting anticholinergic, short-acting bronchodilator, long-acting anticholinergic, long-acting beta2-agonist, and inhaled corticosteroid is recommended for patients with COPD	No information available

Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICU, intensive care unit.

Figure S1 Organizational questionnaire used to evaluate care within hospital services for patients with respiratory diseases such as COPD.

Notes: This material has not been reviewed by European Respiratory Society prior to release; therefore the European Respiratory Society may not be responsible for any errors, omissions or inaccuracies, or for any consequences arising there from, in the content. Adapted and reproduced with permission of the European Respiratory Society: An International Comparison of COPD Care in COPD Care in Europe. Results of the First European COPD Audit. Published by European Respiratory Society ©. First Edition 2012.

Table S1 Characteristics of the Directors of Department of Internal Medicine (n=22)

Age (mean ± SD; years)	45.40±9.31
Male (N; %)	19 (86.4)
Nationality (N; %)
Saudi	7 (31.8)
Non-Saudi	15 (68.2)
Position (N; %)
Internal medicine consultant	7 (31.8)
Internal medicine specialist	12 (54.5)
Respiratory physician consultant	3 (13.6)

Table S2 Summary of the current health care providers involved in COPD care in hospital in the Eastern province

Area	Eastern area: n=14															Al-Ahsa area: n=5						Hafar Al-Batin area: n=3				Total (N)
Hospitals	Total (N)	A	B	C	D	E	F	G	H	I	J	K	L	M	N	Total (N)	O	P	Q	R	S	Total (N)	T	U	V
Respiratory physicians
Consultants	8	3	0	0	0	0	0	0	0	0	0	4	0	1	0	2	2	0	0	0	0	0	0	0	0	10
Specialists	7	1	0	0	0	0	0	0	0	0	0	5	0	1	0	3	3	0	0	0	0	1	1	0	0	11
Residents	1	0	0	0	0	0	0	0	0	0	0	1	0	0	0	2	2	0	0	0	0	0	0	0	0	3
Respiratory therapists	28	6	0	0	0	0	0	0	0	0	0	10	10	2	0	1	0	0	0	0	1	0	0	0	0	29
Physiotherapists	2	0	0	0	0	0	0	0	0	0	0	0	0	0	2	1	0	0	0	0	1	0	0	0	0	3
Others (mental health specialists, respiratory nurses, and dieticians)	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Percentage of COPD patients seen by internal medicine physicians (%)	–	100	100	0	100	100	100	100	100	100	100	0	100	100	100	–	0	90**	90**	90**	40**	–	100	100	100	–

Notes: A to V refers to a different specific hospital. *Patients with COPD were referred to the nearest hospital (hospital L). **The remaining patients were seen by general physicians.