Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 26:18:985-993.
doi: 10.2147/COPD.S408307. eCollection 2023.

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

Andrea Vukić Dugac  1   2 , Mirna Vergles  3 , Sanda Škrinjarić Cincar  4 , Ljiljana Bulat Kardum  5 , Marina Lampalo  1 , Sanja Popović-Grle  1   2 , Jelena Ostojić  6 , Tatjana Tokić Vuksan-Ćusa  7 , Žarko Vrbica  8   9 , Emilija Lozo Vukovac  10 , Neven Tudorić  11
Affiliations

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

Andrea Vukić Dugac et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Introduction: Acute exacerbations in chronic obstructive pulmonary disease (AECOPD) lead to poor outcomes and increased burden for patients and healthcare systems. The Global Initiative for COPD (GOLD) includes specific recommendations for AECOPD interventions, discharge criteria, and follow-up. Aligning the AECOPD discharge letters (DL) with GOLD guidelines could facilitate dissemination of recommendations among general practitioners (GPs).

Purpose: This study was conducted to assess the compliance of DL with the GOLD recommendations in Croatia.

Methods: Pre-pandemic DL of patients presenting for AECOPD to emergency room (ER) were analyzed and stratified by clinical decision to hospitalize (HDL) or discharge patients for outpatient treatment (ERDL). Experienced pulmonologists checked the information from DL against guidelines by using online study-specific questionnaires.

Results: In total, 225 HDL and 368 ERDL were analyzed. In most cases, the GOLD ABCD categories (85% HDL, 92% ERDL) or the spirometry-based degree of severity (90% HDL, 91% ERDL) were not included. The number of AEs in the previous year was recorded, but the specific frequent exacerbator phenotype not explicitly stated. The AE phenotype was included in two thirds of HDL and one third of ERDL. The blood eosinophil count was frequently available, but not considered decision-relevant information. Adjustments of previous maintenance therapy, mostly escalation, were recommended in 58.4% HDL and 27.9% ERDL, respectively. Education on proper use of inhalers was recommended only in 15.6% of HDL. Smoking cessation measures were advised in 23.1% HDL and 7.9% ERDL; pulmonary rehabilitation in 35.6% HDL and 0.8% ERDL. Early follow-up was frequently advised (>50%), but rarely appointed.

Conclusion: Significant deficiencies in compliance with the GOLD guidelines were identified, translating into a missed opportunity for GPs to become acquainted with GOLD recommendations. These findings emphasize the necessity to increase compliance with guidelines first at specialist level and consequent standardization of DL.

Keywords: COPD; GOLD guidelines; acute exacerbation; discharge record.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Changes made at discharge in maintenance treatment recommendations. (A) Hospitalized patients; (B) patients discharged from emergency room.
See this image and copyright information in PMC

References

    1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2095–2128. doi:10.1016/S0140-6736(12)61728-0 - DOI - PMC - PubMed
    1. Ford ES. Trends in mortality from chronic obstructive pulmonary disease among adults in the United States. Chest. 2015;148(4):962–970. doi:10.1378/chest.14-2311.Trends - DOI - PMC - PubMed
    1. World Health Organization. Chronic obstructive pulmonary disease (COPD); 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pul...). Accessed May 23, 2023.
    1. Adeloye D, Song P, Zhu Y, Campbell H, Sheikh A, Rudan I. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;10(5):447–458. doi:10.1016/S2213-2600(21)00511-7 - DOI - PMC - PubMed
    1. Gross NJ, Barnes PJ. New therapies for asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;195(2):159–166. doi:10.1164/rccm.201610-2074PP - DOI - PubMed