Inhospital management of COPD exacerbations: a systematic review of the literature with regard to adherence to international guidelines
Corresponding Author
Cathy Lodewijckx RN MSc PhD Cand
Clinical Nurse Specialist COPD, University Hospitals Leuven, Leuven, Belgium; Research Fellow and PhD Candidate, Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; European Pathway Association, Leuven, Belgium
Cathy LodewijckxEuropean Pathway AssociationE-P-A (IVZW)Kapucijnenvoer 35/4B-3000 LeuvenBelgiumE-mail: [email protected]Search for more papers by this authorWalter Sermeus RN MSc PhD
Professor in Patient Care Management, Research Methods and Biostatistics, Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; Programme Director Master in Nursing & Midwifery and Master in Healthcare Management, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; Treasurer of the European Pathway Association, Leuven, Belgium
Search for more papers by this authorKris Vanhaecht RN MSc PhD
Senior Research Fellow, Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; Secretary General, European Pathway Association, Leuven, Belgium
Search for more papers by this authorMassimiliano Panella MD PhD
Professor in Public Health, Department of Clinical and Experimental Medicine, Faculty of Medicine, Amedeo Avogadro University of Eastern Piemont, Piemont, Italy; Medical Director, Healthcare District of Vercelli, Vercelli, Italy; President of the European Pathway Association, Leuven, Belgium
Search for more papers by this authorSvin Deneckere RN MSc PhD Cand
Research Fellow and PhD Candidate, Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; European Pathway Association, Leuven, Belgium
Search for more papers by this authorFabrizio Leigheb MD PhD Cand
Research fellow and PhD candidate, School of Public Health, Faculty of Medicine, Amedeo Avogadro University of Eastern Piemont, Piemont, Italy; European Pathway Association, Leuven, Belgium
Search for more papers by this authorMarc Decramer MD PhD
Head Respiratory Department, University Hospitals Leuven, Leuven, Belgium; Professor of the Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; Vice President of the European Respiratory Society, Lausanne, Switzerland
Search for more papers by this authorCorresponding Author
Cathy Lodewijckx RN MSc PhD Cand
Clinical Nurse Specialist COPD, University Hospitals Leuven, Leuven, Belgium; Research Fellow and PhD Candidate, Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; European Pathway Association, Leuven, Belgium
Cathy LodewijckxEuropean Pathway AssociationE-P-A (IVZW)Kapucijnenvoer 35/4B-3000 LeuvenBelgiumE-mail: [email protected]Search for more papers by this authorWalter Sermeus RN MSc PhD
Professor in Patient Care Management, Research Methods and Biostatistics, Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; Programme Director Master in Nursing & Midwifery and Master in Healthcare Management, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; Treasurer of the European Pathway Association, Leuven, Belgium
Search for more papers by this authorKris Vanhaecht RN MSc PhD
Senior Research Fellow, Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; Secretary General, European Pathway Association, Leuven, Belgium
Search for more papers by this authorMassimiliano Panella MD PhD
Professor in Public Health, Department of Clinical and Experimental Medicine, Faculty of Medicine, Amedeo Avogadro University of Eastern Piemont, Piemont, Italy; Medical Director, Healthcare District of Vercelli, Vercelli, Italy; President of the European Pathway Association, Leuven, Belgium
Search for more papers by this authorSvin Deneckere RN MSc PhD Cand
Research Fellow and PhD Candidate, Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; European Pathway Association, Leuven, Belgium
Search for more papers by this authorFabrizio Leigheb MD PhD Cand
Research fellow and PhD candidate, School of Public Health, Faculty of Medicine, Amedeo Avogadro University of Eastern Piemont, Piemont, Italy; European Pathway Association, Leuven, Belgium
Search for more papers by this authorMarc Decramer MD PhD
Head Respiratory Department, University Hospitals Leuven, Leuven, Belgium; Professor of the Faculty of Medicine, Catholic University Leuven, Leuven, Belgium; Vice President of the European Respiratory Society, Lausanne, Switzerland
Search for more papers by this authorAbstract
Rationale Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of hospitalization. Suboptimal inhospital management is expected to lead to more frequent exacerbations and recurrent hospital admission, and is associated with increased mortality.
Aims To explore inhospital management of COPD and to compare the results with recommendations from international guidelines.
Methods A literature search was carried out for relevant articles published 2000–2009 in the databases Medline, Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and Invert. In addition, the reference lists of the selected articles were examined. Main inclusion criteria were as follows: COPD, exacerbation, hospitalization, description of inpatient management, and clinical trials. Assessment and treatment strategies in different studies were analysed and compared with American Thoracic Society-European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease guidelines. Outcomes were analysed.
Results Seven eligible studies were selected. Non-pharmacological treatment was infrequently explored. When compared with international guidelines, diagnostic assessment and therapy were suboptimal, especially non-pharmacological treatment. Respiratory physicians were more likely to perform recommended interventions than non-respiratory physicians.
Conclusions Adherence to international guidelines is low for inhospital management of COPD exacerbations, especially in terms of non-pharmacological treatment. Further investigation is recommended to explore strategies like care pathways that improve performance of recommended interventions.
References
- 1 Izquierdo, J. L., Barcina, C., Jimenez, J., Munoz, M. & Leal, M. (2009) Study of the burden on patients with chronic obstructive pulmonary disease. International Journal of Clinical Practice, 63 (1), 87–97.
- 2
Seemungal, T. A.,
Donaldson, G. C.,
Paul, E. A.,
Bestall, J. C.,
Jeffries, D. J. &
Wedzicha, J. A. (1998) Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.
American Journal of Respiratory and Critical Care Medicine, 157 (5
Pt 1), 418–422.
10.1164/ajrccm.157.5.9709032 Google Scholar
- 3 Burge, S. & Wedzicha, J. A. (2003) COPD exacerbations: definitions and classifications. European Respiratory Journal Supplement, 41, 46s–53s.
- 4 Cao, Z., Ong, K. C., Eng, P., Tan, W. C. & Ng, T. P. (2006) Frequent hospital readmissions for acute exacerbation of COPD and their associated factors. Respirology, 11 (2), 188–195.
- 5 Garcia-Aymerich, J., Farrero, E., Felez, M. A., Izquierdo, J., Marrades, R. M. & Anto, J. M. (2003) Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax, 58 (2), 100–105.
- 6 Gibson, P. G., Wlodarczyk, J. H., Wilson, A. J. & Sprogis, A. (1998) Severe exacerbation of chronic obstructive airways disease: health resource use in general practice and hospital. Journal of Quality in Clinical Practice, 18, 125–133.
- 7 Roberts, C. M., Lowe, D., Bucknall, C. E., Ryland, I., Kelly, Y. & Pearson, M. G. (2002) Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax, 57 (2), 137–141.
- 8 Wouters, E. F. (2003) Economic analysis of the Confronting COPD survey: an overview of results. Respiratory Medicine, 97 (Suppl. C), S3–S14.
- 9 Doll, H., Grey-Amante, P., Duprat-Lomon, I., Sagnier, P. P., Thate-Waschke, I., Lorenz, J., Rychlik, R. & Pfeil, T. (2002) Quality of life in acute exacerbation of chronic bronchitis: results from a German population study. Respiratory Medicine, 96 (1), 39–51.
- 10 Llor, C., Molina, J., Naberan, K., Cots, J. M., Ros, F. & Miravitlles, M. (2008) Exacerbations worsen the quality of life of chronic obstructive pulmonary disease patients in primary healthcare. International Journal of Clinical Practice, 62 (4), 585–592.
- 11 Wang, Q. & Bourbeau, J. (2005) Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD. Respirology, 10 (3), 334–340.
- 12 Choi, P. P., Day, A. & Etchells, E. (2004) Gaps in the care of patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease. Canadian Medical Association Journal, 170 (9), 1409–1413.
- 13 Pierson, D. J. (2006) Clinical practice guidelines for chronic obstructive pulmonary disease: a review and comparison of current resources. Respiratory Care, 51 (3), 277–288.
- 14 Centre for Reviews and Dissemination (2001) Undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews. CRD Report Number 4 (2nd Edition). Available at: http://www.york.ac.uk/inst/crd/report4.htm (last accessed 9 March 2009).
- 15 Bratzler, D. W., Oehlert, W. H., McAdams, L. M., Leon, J., Jiang, H. & Piatt, D. (2004) Management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: physician practices in the community hospital setting. Journal of the Oklahoma State Medical Association, 97 (6), 227–232.
- 16 Chang, C. L., Sullivan, G. D., Karalus, N. C., Hancox, R. J., McLachlan, J. D. & Mills, G. D. (2007) Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome. Internal Medicine Journal, 37 (4), 236–241.
- 17 Cydulka, R. K., Rowe, B. H., Clark, S., Emerman, C. L. & Camargo, C. A., Jr (2003) Emergency department management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: the Multicenter Airway Research Collaboration. Journal of the American Geriatrics Society, 51 (7), 908–916.
- 18 Harvey, P. A., Murphy, M. C., Dornom, E., Berlowitz, D. J., Lim, W. K. & Jackson, B. (2005) Implementing evidence-based guidelines: inpatient management of chronic obstructive pulmonary disease. Internal Medicine Journal, 35, 151–155.
- 19 Kelly, M. G. & Elborn, J. S. (2002) Admissions with chronic obstructive pulmonary disease after publication of national guidelines. Irish Journal of Medical Science, 171 (1), 16–19.
- 20 Lindenauer, P. K., Pekow, P., Gao, S., Crawford, A. S., Gutierrez, B. & Benjamin, E. M. (2006) Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Annals of Internal Medicine, 144 (1), 894–903.
- 21 Roberts, C. M., Ryland, I., Lowe, D., Kelly, Y., Bucknall, C. E. & Pearson, M. G. (2001) Audit of acute admissions of COPD: standards of care and management in the hospital setting. European Respiratory Journal, 17 (3), 343–349.
- 22 Khan, K., Riet, G., Popay, J., Nixon, J. & Kleijnen, J. (2001) Study quality assessment (stage II, phase 5). In undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews. CRD Report Number 4 (2nd Edition). Available at: http://www.york.ac.uk/inst/crd/report4.htm (last accessed 9 March 2009).
- 23 Deeks, J., Khan, K., Song, F., Popay, J., Nixon, J. & Kleiijnen, J. (2001) Data synthesis (stage II phase 7). In undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews. CRD Report Number 4 (2nd Edition). Available at: http://www.york.ac.uk/inst/crd/report4.htm (last accessed 9 March 2009).
- 24 Anthonisen, N. R., Manfreda, J., Warren, C. P., Hershfield, E. S., Harding, G. & Nelson, N. A. (1987) Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Annals of Internal Medicine, 106 (2), 196–204.
- 25 The National Collaborating Centre for Chronic Conditions (2004) Diagnosing COPD. In national clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Available at: http://guidance.nice.org.uk/CG12 (last accessed 9 March 2009).
- 26 Celli, B. R. & Macnee, W. (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. European Respiratory Journal, 23 (6), 932–946.
- 27 Global Initiative for Chronic Obstructive Lung Disease (2008) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2007. Available at: http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=996 (last accessed 9 March 2009).
- 28 Siafakas, N. M., Vermeire, P., Pride, N. B., Paoletti, P., Gibson, J., Howard, P., Yernault, J. C., Decramer, M., Higenbottam, T. & Postma, D. S. (1995) Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. European Respiratory Journal, 8 (8), 1398–1420.
- 29 American Thoracic Society (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 152 (5 Pt 2), S77–S121.
- 30 Pelkonen, M. (2008) Smoking: relationship to chronic bronchitis, chronic obstructive pulmonary disease and mortality. Current Opinion in Pulmonary Medicine, 14 (2), 105–109.
- 31 Burrows, B., Knudson, R. J., Cline, M. G. & Lebowitz, M. D. (1977) Quantitative relationships between cigarette smoking and ventilatory function. The American Review of Respiratory Disease, 115 (2), 195–205.
- 32 Barbera, J. A., Roca, J., Ferrer, A., Felez, M. A., Diaz, O., Roger, N. & Rodriguez-Roisin, R. (1997) Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. European Respiratory Journal, 10 (6), 1285–1291.
- 33 Calverley, P. M. (2000) Oxygen-induced hypercapnia revisited. Lancet, 356 (9241), 1538–1539.
- 34
Siafkas, N. &
Wedzicha, J. (2006) Management of acute exacerbation of chronic obstructive pulmonary disease. In
Management of Chronic Obstructive Pulmonary Disease (ed.
N. Siafkas), pp.
387–400. Sheffield: European Respiratory Society Ltd.
10.1183/1025448x.00038024 Google Scholar
- 35 Emerman, C. L. & Cydulka, R. K. (1996) Use of peak expiratory flow rate in emergency department evaluation of acute exacerbation of chronic obstructive pulmonary disease. Annals of Emergency Medicine, 27 (10), 159–163.
- 36 Emerman, C. L., Lukens, T. W. & Effron, D. (1994) Physician estimation of FEV1 in acute exacerbation of COPD. Chest, 105 (6), 1709–1712.
- 37 Emerman, C. L., Effron, D. & Lukens, T. W. (1991) Spirometric criteria for hospital admission of patients with acute exacerbation of COPD. Chest, 99 (3), 595–599.
- 38 Nikander, K., Turpeinen, M. & Wollmer, P. (1999) The conventional ultrasonic nebulizer proved inefficient in nebulizing a suspension. Journal of Aerosol Medicine, 12 (2), 47–53.
- 39 Rau, J. L. (2002) Design principles of liquid nebulization devices currently in use. Respiratory Care, 47, 1257–1275.
- 40 Rodriguez-Roisin, R. (2000) Toward a consensus definition for COPD exacerbations. Chest, 117 (5 Suppl. 2), 398S–401S.
- 41 Mitrouska, I., Tzanakis, N. & Siafkas, N. (2007) Oxygen therapy in chronic obstructive pulmonary disease. In Management of Chronic Obstructive Pulmonary Disease (ed. N. Siafkas), pp. 302–312. Sheffield: European Respiratory Society Ltd.
- 42 Chen, A. M., Bollmeier, S. G. & Finnegan, P. M. (2008) Long-acting bronchodilator therapy for the treatment of chronic obstructive pulmonary disease. The Annals of Pharmacotherapy, 42 (12), 1832–1842.
- 43 Rennard, S. & Calverly, P. (2006) Bronchodilators in chronic obstructive pulmonary disease. In Management of Chronic Obstructive Pulmonary Disease (ed. N. Siafkas), pp. 266–280. Sheffield: European Respiratory Society Ltd.
- 44 Fink, J. B. & Rubin, B. K. (2005) Problems with inhaler use: a call for improved clinician and patient education. Respiratory Care, 50 (10), 1360–1374.
- 45 Rau, J. L. (2005) Determinants of patient adherence to an aerosol regimen. Respiratory Care, 50 (10), 1346–1356.
- 46 Molimard, M. (2005) How to achieve good compliance and adherence with inhalation therapy. Current Medical Research and Opinion, 21 (Suppl. 4), S33–S37.
- 47 Pitta, F., Troosters, T., Probst, V. S., Spruit, M. A., Decramer, M. & Gosselink, R. (2006) Physical activity and hospitalization for exacerbation of COPD. Chest, 129 (3), 536–544.
- 48 Puhan, M. A., Scharplatz, M., Troosters, T. & Steurer, J. (2005) Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality: a systematic review. Respiratory Research, 6, 54.
- 49 Gruffydd-Jones, K., Langley-Johnson, C., Dyer, C., Badlan, K. & Ward, S. (2007) What are the needs of patients following discharge from hospital after an acute exacerbation of chronic obstructive pulmonary disease (COPD)? Primary Care Respiratory Journal, 16 (6), 363–368.
- 50 Dheda, K., Crawford, A., Hagan, G. & Roberts, C. M. (2004) Implementation of British Thoracic Society guidelines for acute exacerbation of chronic obstructive pulmonary disease: impact on quality of life. Postgraduate Medical Journal, 80, 169–171.
- 51 Bott, J., Carroll, M. P., Conway, J. H., et al. (1993) Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet, 341 (8860), 1555–1557.
- 52 Brochard, L., Mancebo, J., Wysocki, M., et al. (1995) Non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. The New England Journal Medicine, 333, 817–822.
- 53 European Respiratory Society, European Society of Intensive Care Medicine & Société de Réanimation de Langue Française (2001) International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure. American Journal of Respiratory Critical Care Medicine, 163 (1), 283–291.
- 54 Kramer, N., Meyer, T. J., Meharg, J., Cece, R. D. & Hill, N. S. (1995) Randomized, prospective trial of non-invasive positive pressure ventilation in acute respiratory failure. American Journal of Respiratory Critical Care Medicine, 151 (6), 1799–1806.
- 55 Plant, P. K., Owen, J. L. & Elliott, M. W. (2000) Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet, 355 (9219), 1931–1935.
- 56 Angus, R. M., Murray, S., Kay, J. W., Thomson, N. C. & Patel, K. R. (1994) Management of chronic airflow obstruction: differences in practice between respiratory and general physicians. Respiratory Medicine, 88 (7), 493–497.
- 57 Price, L. C., Lowe, D., Hosker, H. S., Anstey, K., Pearson, M. G. & Roberts, C. M. (2006) UK National COPD Audit 2003: impact of hospital resources and organization of care on patient outcome following admission for acute COPD exacerbation. Thorax, 61 (10), 837–842.
- 58 Roberts, C. M., Barnes, S., Lowe, D. & Pearson, M. G. (2003) Evidence for a link between mortality in acute COPD and hospital type and resources. Thorax, 58 (11), 947–949.
- 59 Ruse, C. E. & Molyneux, A. W. (2005) A study of the management of COPD according to established guidelines and the implications for older patients. Age and Ageing, 34 (3), 299–301.
- 60 Almagro, P., Barreiro, B., Ochoa De Echaguen, A., Quintana, S., Rodriguez, C. M., Heredia, J. L. & Garau, J. (2006) Risk factors for hospital readmission in patients with chronic obstructive pulmonary disease. Respiration, 73 (3), 311–317.
- 61 Bustamante-Fermosel, A., De Miguel-Yanes, J. M., Duffort-Falco, M. & Munoz, J. (2007) Mortality-related factors after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: the burden of clinical features. American Journal of Emergency Medicine, 25 (5), 515–522.
- 62 Groenewegen, K. H., Schols, A. M. & Wouters, E. F. (2003) Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest, 124 (2), 459–467.
- 63 Gunen, H., Hacievliyagil, S. S., Kosar, F., Mutlu, L. C., Gulbas, G., Pehlivan, E., Sahin, I. & Kizkin, O. (2005) Factors affecting survival of hospitalized patients with COPD. European Respiratory Journal, 26 (2), 234–241.
- 64 Yohannes, A. M., Baldwin, R. C. & Connolly, M. J. (2005) Predictors of 1-year mortality in patients discharged from hospital following acute exacerbation of chronic obstructive pulmonary disease. Age and Ageing, 34 (5), 491–496.
- 65 Bandolier (2003) Independent evidence-based health care. On care pathways. Available at: http://www.medicine.ox.ac.uk/bandolier/Extraforbando/Forum2.pdf (last accessed 18 June 2009).
- 66 Panella, M., Marchisio, S. & Di, S. F. (2003) Reducing clinical variations with clinical pathways: do pathways work? International Journal for Quality in Health Care, 15 (6), 509–521.
- 67 Pearson, S. D., Goulart-Fisher, D. & Lee, T. H. (1995) Critical pathways as a strategy for improving care: problems and potential. Annals of Internal Medicine, 123 (12), 941–948.
- 68 Sermeus, W., De Bleser, L., Depreitere, R., De Waele, K., Vanhaecht, K. & Vlayen, J. (2005) An introduction to clinical pathways. In The Use of Clinical Pathways and Guidelines to Determine Physicians' Hospital Fees Prospectively: Easier Said Than Done (eds S. Devriese, M. L. Lambert, M. Eyssen, S. Van De Sande, J. Poelmans, H. Van Brabandt, W. Sermeus, J. Vlayen & D. Ramaekers). KCE Reports, Volume 18A. Brussels: Belgian Healthcare Knowledge Centre (KCE). Available at: http://www.kce.fgov.be/index_en.aspx?SGREF=5221&CREF=5362 (last accessed 18 June 2009).
- 69 Trowbridge, R. & Weingarten, S. (2001) Making health care safer, a critical analysis of patient safety practices. Chapter 52: Critical Pathways. Agency for Healthcare Research & Quality. Available at: http://www.ahrq.gov/clinic/ptsafety/chap52.htm (last accessed 18 June 2009).
- 70
Vanhaecht, K.,
Bollmann, M.,
Bower, K., et al. (2006) Prevalence and use of clinical pathways in 23 countries – an international survey by the European Pathway Association (
http://www.E-P-A.org
).
Journal of Integrated Care Pathways, 10, 28–34.
10.1258/j.jicp.2006.124 Google Scholar
- 71 Vanhaecht, K., De Witte, K. & Sermeus, W. (2007) The Impact of Clinical Pathways on the Organization of Care Processes. Leuven: ACCO.
- 72 Vanhaecht, K., De Witte, K., Depreitere, R. & Sermeus, W. (2006) Clinical pathway audit tools: a systematic review. Journal of Nursing Management, 14 (7), 529–537.
Citing Literature
