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. 2024 Nov;19(8):2241-2248.
doi: 10.1007/s11739-024-03592-w. Epub 2024 Apr 11.

Management of acute exacerbations of COPD in the emergency department and its associations with clinical variables

Ophir Freund  1   2   3 , Ariel Melloul  4   5 , Sabrina Fried  4   5 , Eyal Kleinhendler  4   5 , Avraham Unterman  4   5 , Evgeni Gershman  4   5 , Avishay Elis  5   6 , Amir Bar-Shai  4   5
Affiliations

Management of acute exacerbations of COPD in the emergency department and its associations with clinical variables

Ophir Freund et al. Intern Emerg Med. 2024 Nov.

Abstract

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause for emergency department (ED) visits. Still, large scale studies that assess the management of AECOPD in the ED are limited. Our aim was to evaluate treatment characteristics of AE-COPD in the ED on a national scale. A prospective study as part of the COPD Israeli survey, conducted between 2017 and 2019, in 13 medical centers. Patients hospitalized with AECOPD were included and interviewed. Clinical data related to their ED and hospital stay were collected. 344 patients were included, 38% females, mean age of 70 ± 11 years. Median (IQR) time to first ED treatment was 59 (23-125) minutes and to admission 293 (173-490) minutes. Delayed ED treatment (> 1 h) was associated with older age (p = 0.01) and lack of a coded diagnosis of COPD in hospital records (p = 0.01). Long ED length-of-stay (> 5 h) was linked with longer hospitalizations (p = 0.01). Routine ED care included inhalations of short-acting bronchodilators (246 patients, 72%) and systemic steroids (188 patients, 55%). Receiving routine ED care was associated with its continuation during hospitalization (p < 0.001). In multivariate analysis, predictors for patients not receiving routine care were obesity (adjusted odds ratio 0.5, 95% CI 0.3-0.8, p = 0.01) and fever (AOR 0.3, 95% CI 0.1-0.6, p < 0.01), while oxygen saturation < 91% was an independent predictor for ED routine treatment (AOR 3.6, 95% CI 2.1-6.3, p < 0.01). Our findings highlight gaps in the treatment of AECOPD in the ED on a national scale, with specific predictors for their occurrence.

Keywords: Chronic obstructive pulmonary disease; Diagnosis; Hospitalization; Short-acting bronchodilators; Steroids.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no conflicts of interest. Ethical approval: Our study was approved by the institutional ethics boards. All included patients signed informed consent. Human and animal rights statement and informed consent: The study was approved by each center's institutional ethical committee and conducted in accordance with the Helsinki declaration. All subjects signed an informed consent form.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curve of time from hospital arrival to admission, divided to patients with and without ambulance transfer. Comparison between the groups performed by the log-rank test
See this image and copyright information in PMC

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