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Open Access 11-04-2024 | Chronic Obstructive Lung Disease | EM - ORIGINAL

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

Authors: Ophir Freund, Ariel Melloul, Sabrina Fried, Eyal Kleinhendler, Avraham Unterman, Evgeni Gershman, Avishay Elis, Amir Bar-Shai

Published in: Internal and Emergency Medicine | Issue 8/2024

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.

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Title: Management of acute exacerbations of COPD in the emergency department and its associations with clinical variables
Authors: Ophir Freund
Ariel Melloul
Sabrina Fried
Eyal Kleinhendler
Avraham Unterman
Evgeni Gershman
Avishay Elis
Amir Bar-Shai
Publication date: 11-04-2024
Publisher: Springer International Publishing
Keyword: Chronic Obstructive Lung Disease
Published in: Internal and Emergency Medicine / Issue 8/2024
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-024-03592-w

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