Assessment and management of chronic obstructive pulmonary disease in the emergency department and beyond

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are common, can result in emergency department presentation and often result in hospitalization. After confirming the diagnosis and treating comorbidities, management of severe AECOPD includes bronchodilators, systemic corticosteroids, antibiotics, noninvasive ventilation and, occasionally, endotracheal intubation. Once discharged, delayed follow-up and suboptimal management often occurs. Antibiotics, systemic corticosteroids and optimization of nonpharmacological interventions (e.g., smoking cessation, immunization and pulmonary rehabilitation) are important discharge considerations. Improving linkages to primary providers who adhere to management involving a pharmacological and nonpharmacological evidence-based treatment plan is critical to preventing future AECOPDs, reducing healthcare utilization and maintaining the quality of life of patients following an AECOPD.

Keywords::

• AECOPD
• antibiotics
• COPD
• corticosteroids
• emergency department
• exacerbation
• prevention

Financial & competing interests disclosure

Brian Rowe is supported by a 21st Century Canada Research Chair in Emergency Airway Diseases from the Canadian Institutes of Health Research (CIHR) through the Government of Canada (Ottawa, Canada). Since 2008, Brian Rowe has received support for participation in conferences, consulting and medical research from industry sponsors with an interest in COPD including AstraZeneca and GlaxoSmithKline. Brian Rowe does not own stocks or other ownership interest in any of these companies. Mohit Bhutani has received support for participation in conferences, consulting and medical research from industry sponsors with an interest in COPD including GlaxoSmithKline, AstraZeneca, Novartis, Nycomed, Pfizer and Boerhinger Ingelheim. Mohit Bhutani does not own stocks or other ownership interest in any of these companies. Mike Stickland is supported by the CIHR through a New Investigator Award (Ottawa, Canada). Mike Stickland has received operational support for his research from: CIHR, Heart and Stroke Foundation of Canada and Alberta Lung Association. Since 2008, Mike Stickland has received speaking honorariums from GlaxoSmithKline. Mike Stickland does not own stocks or other ownership interest in this company. Rita Cydulka has received financial support from a variety of groups for participation in conferences, consulting and medical research. These groups include government agencies, private foundations, professional organizations and industry. Since 2008, industry sponsors with an interest in COPD included Boehringer-Ingelheim. Rita Cydulka does not own stocks or other ownership interest in this company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.