Treatment of acute COPD exacerbations in rural Alberta emergency departments

Abstract

Introduction: Acute exacerbations of COPD (AECOPD) are common presentations to emergency departments (ED); however, limited information exists for the management in nonurban locations. We sought to examine the diagnostic and treatment approaches to patients with AECOPD in three rural EDs and determine levels of adherence to recommendations contained within clinical practice guidelines. Methods: Using retrospective chart review methods, we evaluated the difference in treatment of AECOPD among three EDs in rural Alberta. Cases were chosen for review based on ICD-10 codes J41-44. Data are reported as median and interquartile ranges (IQR) and proportions. Results: Over a 1-year study period, 192 patients presented a total of 266 times with AECOPD. The average age was 68 (IQR: 58, 77), and 54.9% were females. Diagnostic testing included chest x-ray in 65.0%, bloodwork in 45.1%, ECG in 33.5%, and ABGs in 6.4%; few received pulmonary function testing. In the ED, 58.7% of patients were treated with a short-acting beta-agonist (SABA), 48.9% with a short-acting anticholinergic (SAAC), 27.4% with corticosteroids, and 19.9% with antibiotics. Overall, SABAs (63.5%), anticholinergic agents (53.4%), corticosteroids (54.5%), and antibiotics (71.1%) were prescribed more commonly to discharged patients (all p < 0.05). Conclusion: There are low to moderate levels of adherence to clinical practice guidelines in the rural ED management of AECOPD. Further research might compare these results to rural and urban settings or examine whether readily available point-of-care treatment maps or checklists improve adherence to CPG recommendations.