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Multicenter Study
. 2025 May:87:101159.
doi: 10.1016/j.resmer.2025.101159. Epub 2025 Jan 31.

Management of severe exacerbations of COPD by French intensivists and adherence to guidelines

Luc Haudebourg  1 , Morgane Faure  2 , Martin Dres  3 , Nicolas Roche  4 , Nicolas Terzi  5 , Elise Morawiec  6 , Julie Delemazure  6 , Armand Mekontso-Dessap  7 , Thomas Similowski  8 , Maxens Decavèle  3 , Alexandre Demoule  3
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Free article
Multicenter Study

Management of severe exacerbations of COPD by French intensivists and adherence to guidelines

Luc Haudebourg et al. Respir Med Res. 2025 May.
Free article

Abstract

Background: Severe exacerbations of chronic obstructive pulmonary disease (ECOPD) require hospitalization in intensive care unit (ICU) in 10 % of cases. This study aims to describe current practices for the management of severe ECOPD in the ICU and to evaluate adherence to the 2017 French guidelines.

Methods: From March to May 2019, we conducted a cross-sectional multicenter survey across 80 ICUs in France. A 9-item questionnaire exploring physicians practices in terms of diagnostic workup and management of severe ECOPD was sent to participating centers.

Results: Four hundred and thirty-eight physicians responded to the survey, 75 % were senior physicians, 39 % were certified medical intensivists and 67 % worked in a medical or respiratory ICU. Nebulized short-acting beta agonists prescription was mostly driven by the presence of wheezing, silent chest or respiratory failure, even though guidelines recommend them systematically for ECOPD (moderate adhesion to guidelines). Antibiotic prescription was mostly driven by increased sputum purulence and volume, fever, signs of respiratory distress or the severity of the underlying COPD, but was not deemed systematic in case of severity signs (poor adhesion to guidelines). Regarding the use of biomarkers for antibiotics prescription, adhesion to guidelines was moderate. The prescription of systemic corticosteroids was not deemed systematic but was rather considered if no improvement was observed 72 h after admission (good adhesion to guidelines).

Conclusion: Reported management of severe ECOPD does not follow all guidelines. Future works should focus on understanding barriers to clinical practice guidelines implementation.

Keywords: Antibiotics; Exacerbation of chronic obstructive pulmonary disease; Intensive care unit; Short-acting beta agonists; Systemic corticosteroids.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Morgane FAURE reports a relationship with General Electric Company that includes: funding grants and travel reimbursement. Morgane FAURE reports a relationship with Pfizer that includes: funding grants and travel reimbursement. Morgane FAURE reports a relationship with Bayer HealthCare SAS that includes: travel reimbursement. Morgane FAURE reports a relationship with Actelion Pharmaceuticals France SAS that includes: travel reimbursement. Martin DRES reports a relationship with Lungpacer Medical Inc that includes: funding grants. Nicolas ROCHE reports a relationship with Boehringer Ingelheim Pharmaceuticals Inc that includes: funding grants. Nicolas ROCHE reports a relationship with Novartis that includes: funding grants. Nicolas ROCHE reports a relationship with Pfizer that includes: funding grants. Nicolas Roche reports a relationship with GSK that includes: funding grants. Nicolas ROCHE reports a relationship with Austral that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas ROCHE reports a relationship with Biosency that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas ROCHE reports a relationship with MSD France SAS that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas ROCHE reports a relationship with AstraZeneca Pharmaceuticals LP that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas ROCHE reports a relationship with Chiesi Pharmaceuticals Inc that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas ROCHE reports a relationship with Menarini Laboratories that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas ROCHE reports a relationship with Nuvaira Inc that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas ROCHE reports a relationship with Sanofi that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas ROCHE reports a relationship with Zambon Pharmaceutical Laboratories that includes: board membership, consulting or advisory, and speaking and lecture fees. Nicolas TERZI reports a relationship with Pfizer France that includes: speaking and lecture fees. Nicolas TERZI reports a relationship with Fisher & Paykel Healthcare Inc that includes: speaking and lecture fees. Nicolas TERZI reports a relationship with Gilead Sciences Inc that includes: travel reimbursement. Thomas SIMILOWSKI reports a relationship with Lungpacer Medical Inc that includes: consulting or advisory and funding grants. Thomas SIMILOWSKI reports a relationship with ADEP Assistance that includes: consulting or advisory. Thomas SIMILOWSKI reports a relationship with AstraZeneca Pharmaceuticals LP that includes: consulting or advisory. Thomas SIMILOWSKI reports a relationship with Chiesi SA France that includes: consulting or advisory. Thomas SIMILOWSKI reports a relationship with KPL that includes: consulting or advisory. Thomas SIMILOWSKI reports a relationship with Novartis that includes: consulting or advisory. Thomas SIMILOWSKI reports a relationship with Teva Santé SAS that includes: consulting or advisory. Thomas SIMILOWSKI reports a relationship with VitalAire France that includes: consulting or advisory. Maxens DECAVELE reports a relationship with ISIS Medical that includes: non-financial support. Alexandre DEMOULE reports a relationship with French Government Ministry of Social Affairs Health and Womens Rights that includes: funding grants. Alexandre DEMOULE reports a relationship with Respinor that includes: consulting or advisory, funding grants, and speaking and lecture fees. Alexandre DEMOULE reports a relationship with Public Assistance Hospitals Paris that includes: consulting or advisory and funding grants. Alexandre DEMOULE reports a relationship with Fisher & Paykel Healthcare Inc that includes: consulting or advisory and speaking and lecture fees. Alexandre DEMOULE reports a relationship with Lungpacer Medical Inc that includes: consulting or advisory and speaking and lecture fees. Alexandre DEMOULE reports a relationship with Liberate Medical that includes: consulting or advisory and speaking and lecture fees. Alexandre DEMOULE reports a relationship with Tribunal administratif de Cergy that includes: consulting or advisory and speaking and lecture fees. Alexandre DEMOULE reports a relationship with Philips that includes: consulting or advisory and speaking and lecture fees. Alexandre DEMOULE reports a relationship with SAT Lutech that includes: consulting or advisory and speaking and lecture fees. Alexandre DEMOULE reports a relationship with Astra that includes: consulting or advisory and speaking and lecture fees. Alexandre DEMOULE reports a relationship with Mindray Medical International Ltd that includes: consulting or advisory and speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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