Admissions with chronic obstructive pulmonary disease after publication of national guidelines

Abstract

Background: The British Thoracic Society (BTS) published guidelines on managing acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in 1997. Aim: To audit admissions with AECOPD and to see how well these guidelines were adhered to. Methods: All patients admitted were identified and 50 selected for audit. Results: The mean age was 72 years and 52% were female. Admission C reactive protein (CRP) and white cell count (WCC) were 49 (12.7) mg/l and 10.97 (0.64) x109/l respectively. Six were acidotic and 16 hypercapnoeic. Median length of stay (LOS) was six days. Twenty-one fulfilled admission criteria. Thirty-seven had ≥ 2 Anthonisen criteria. Nine had spirometry performed. Correlations were seen between appropriateness of admission score and pH (r=-0.41, p=0.01) and LOS (r=-0.43, p=0.002) and between Anthonisen criteria score and age (r=0.33, p=0.018). Symptom score correlated with PaO2 (r=-0.38, p=0.02), LOS (r=0.27, p=0.06) and age (r=0.38, p=0.007). LOS correlated with PaCO2 (r=0.33, p=0.04). Conclusion: Admissions are chiefly comprised of an ill, elderly population. Careful adherence to guidelines could result in fewer admissions.