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Canadian Journal of Respiratory, Critical Care, and Sleep Medicine
Revue canadienne des soins respiratoires et critiques et de la médecine du sommeil
Volume 6, 2022 - Issue 1
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Original Research

Examination of COPD management in patients hospitalized with an acute exacerbation of COPD

ORCID Icon, ORCID Icon & ORCID Icon
Pages 14-23 | Published online: 21 Feb 2020
 

Abstract

BACKGROUND

Optimal chronic obstructive pulmonary disease (COPD) management includes both pharmacologic therapy and non-pharmacologic interventions including smoking cessation, vaccination, patient education/self-management and pulmonary rehabilitation. All of these elements should be optimized prior to hospital discharge in patients admitted for acute exacerbations of COPD (AECOPD).

OBJECTIVES AND METHODS: We conducted a retrospective review of all patients admitted with an AECOPD in Saskatoon, Saskatchewan during 2016 to determine the proportion discharged on medical therapy consistent with the Global Initiative for Obstructive Lung Disease (GOLD) and Canadian Thoracic Society (CTS) guidelines, as well as the proportion who received appropriate non-pharmacologic interventions while in hospital — namely, nicotine replacement therapy (NRT), pneumococcal and influenza vaccination, COPD Nurse-Clinician and Respirologist involvement and pulmonary rehabilitation program (PRP) referral.

RESULTS

A total of 222 admissions were evaluated. Regarding non-pharmacologic management, 48% of smokers were prescribed NRT, while 3% and 24% of patients were vaccinated against pneumococcus and influenza, respectively, while in hospital. A total of 37% of patients were seen by a Respirologist and 66% were assessed by a COPD Nurse-Clinician, but only 8% were referred to PRP prior to discharge. In contrast, 86% of patients were discharged on guideline-adherent pharmacologic therapy. COPD Nurse-Clinician involvement, but not Respirologist involvement, was associated with guideline-adherent medical therapy on discharge.

CONCLUSION

While most patients were discharged on appropriate pharmacologic therapy, the low rates of NRT prescription, pneumococcal and influenza vaccination, and PRP referral in these patients highlight meaningful opportunities for further optimizing care and warrant significant improvement. Given the documented benefits of these therapies in COPD, quality improvement initiatives should be undertaken to promote in-hospital COPD optimization.

RÉSUMÉ

CONTEXTE: La prise en charge optimale de la MPOC comprend à la fois un traitement pharmacologique et des interventions non pharmacologiques, notamment le sevrage tabagique, la vaccination, l'éducation et l’auto-prise en charge du patient, ainsi que la réadaptation pulmonaire. Tous ces éléments doivent être optimisés avant la sortie de l'hôpital chez les patients admis pour des exacerbations aiguës de la MPOC.

OBJECTIFS ET MÉTHODES: Nous avons procédé à un examen rétrospectif de tous les patients admis pour une exacerbation aiguë de la MPOC à Saskatoon, Saskatchewan en 2016, afin de déterminer la proportion de patients ayant reçu un traitement médical conforme aux directives de la Global Initiative for Obstructive Lung Disease (GOLD) et de la Société canadienne de thoracologie (SCT), ainsi que la proportion de personnes ayant bénéficié d'interventions non pharmacologiques appropriées pendant leur hospitalisation, à savoir la thérapie de substitution nicotinique (TSN), la vaccination contre les pneumocoques et la grippe, l'intervention d'une infirmière clinicienne et d'un pneumologue spécialisés dans la MPOC et l'orientation vers un programme de réadaptation pulmonaire.

RÉSULTATS: Au total, 222 admissions ont été évaluées. En ce qui concerne la prise en charge non pharmacologique, 48 % des fumeurs se sont vu prescrire une thérapie de substitution nicotinique, tandis que 3 % et 24 % des patients ont été vaccinés contre le pneumocoque et la grippe, respectivement, pendant leur hospitalisation. Par ailleurs, 37 % des patients ont été vus par un pneumologue et 66 % ont été évalués par une infirmière clinicienne spécialisée dans la MPOC, mais seulement 8 % ont été orientés vers un programme de réadaptation pulmonaire avant leur sortie. En revanche, 86 % des patients ont reçu leur congé en suivant un traitement pharmacologique conforme aux directives. L'implication d'une infirmière clinicienne spécialisée dans la MPOC, mais pas celle d'un pneumologue, a été associée à un traitement médical conforme aux directives lors de la sortie.

CONCLUSION: Bien que la plupart des patients aient reçu leur congé en suivant un traitement pharmacologique approprié, les faibles taux de prescription de trait de substitution nicotinique, de vaccination contre le pneumocoque et la grippe, et d'orientation vers un programme de réadaptation pulmonaire chez ces patients mettent en évidence des possibilités significatives d'optimisation des soins et justifient une amélioration importante. Étant donné les avantages documentés de ces thérapies dans la MPOC, des initiatives d'amélioration de la qualité devraient être entreprises pour promouvoir l'optimisation de la MPOC en milieu hospitalier.

Acknowledgments

The authors would like to thank Rhonda Bryce, of the University of Saskatchewan College of Medicine’s Clinical Research Support Unit, for her assistance with the statistical analysis.

Disclosure of interest

I.M. Wirth has no disclosures.

E.D. Penz has received honoraria and/or expense reimbursement for participation in advisory board activities, speaking engagements or scientific exchange conferences for Astra Zeneca, GlaxoSmithKline and Boehringer Ingelheim in the past. No funding of any kind was received for this study.

D.D. Marciniuk has undertaken consultancy with the Alberta Lung Association, AstraZeneca, Boehringer Ingelheim, Canadian Foundation for Healthcare Improvement, Chinese Committee of Health and Family Planning, GlaxoSmithKline, Health Canada, Lung Association of Saskatchewan, Mylan, Novartis, Saskatchewan Ministry of Health, Saskatchewan Health Authority and Yukon Health and Social Services. He has received research funding (all funds managed by the University of Saskatchewan) from AstraZeneca, Boehringer Ingelheim, Canada Health Infoway, Canadian Institute of Health Research, GlaxoSmithKline, Lung Association of Saskatchewan, Lung Health Institute of Canada, Novartis, Sanofi, Saskatchewan Health Research Foundation and Schering-Plough. He is an employee of the University of Saskatchewan. No funding of any kind was received for this study.

Funding

None

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