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Audit of acute admissions of COPD: standards of care and management in the hospital setting

C.M. Roberts, I. Ryland, D. Lowe, Y. Kelly, C.E. Bucknall, M.G. Pearson
European Respiratory Journal 2001 17: 343-349; DOI:
C.M. Roberts
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I. Ryland
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D. Lowe
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Y. Kelly
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C.E. Bucknall
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M.G. Pearson
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Tables

  • Table 1

    Demographics and disease severity at admission

    sexAdmission
    MaleFemaleFirstRe-admission
    Sex748 (53)622 (44)
    Age72±971±10
    FEV1 L1.09±0.580.81±0.39
    0.94 (0.66–1.31)0.71 (0.55–1.00)
    FEV1 % pred40±2042±19
    35 (25–49)39 (28–53)
    Admission Status400 (29)919 (66)
    Medications recorded at the time of admission
     Inhaled bronchodilator285 (71)674 (73)
     Long-acting bronchodilator30 (8)175 (19)
     Inhaled steroid204 (51)597 (65)
     Systemic steroid110 (28)344 (37)
     One or more of the above four327 (82)845 (92)
     Home nebuliser70 (18)445 (48)
     Home oxygen23 (6)268 (29)
     Methylxanthine50 (13)243 (26)
     Antibiotic63 (16)190 (21)
    • Data presented as n (%), mean±sd and mean (interquartile range)

    • 2% were unknown

    • 6% admission details were unknown

    • Of the 302 cases in which oxygen was reported, the type was stated as oxygen concentrator in 90 cases, and as a cylinder in 110 cases.

  • Table 2

    Assessments and measurements on admission

    Assessment or measurement made on admissionInterhospital variationOverall summary statistics for patients
    n (%)IQR %range %MeansdMedianIQRRange
    Increased breathlessness96% (1347)93–10083–100Symptom present in 96% (1299)
    Increased sputum volume70% (987)52–8512–100Symptom present in 58% (574)
    Change in colour of sputum68% (948)53–829–100Symptom present in 53% (502)
    Bilateral leg oedema66% (923)52–779–97Present in 38% (348)
    Comment on the chest radiograph65% (916)53–780–98Infiltrates reported in 26% (242)
    Respiratory rate bpm70% (982)60–8627–1002772622–3010–60
    Temperature oC86% (1209)85–9737–10036.70.836.626.2–37.234.0–40.0
    Peak flow l·min−146% (648)30–550–884771140100–18510–460
    Sa,O2 %75% (1061)65–915–1009189489–9646–100
    pH79% (1109)73–9040–1007.390.97.407.36–7.456.89–7.80
    Pa,O2 kPa6.212.185.704.81–6.911.56–21.88
    Pa,O2 kPa10.315.09.017.50–11.323.30–48.40
    • IQR: interquartile range

    • bpm: beats per minute

    • Sa,O2: arterial oxygen saturation

    • Pa,CO2: arterial carbon dioxide tension

    • Pa,O2: arterial oxygen tension

    • 114 of these the actual value was marked “unrecordable”. Statistical summary is for the 534 with values.

  • Table 3

    Initial management within 24 h of admission

    Formal prescription of level of inspired oxygen
    Overall64 (886/1375 known)
    Sa,O2≤9275 (328/439)
    >9262 (377/613)
    Pa,O2<8 kPa76 (269/355)
    8–9.99 kPa71 (231/326)
    10+ kPa68 (282/417)
    Repeat arterial blood gases
    Overall34 (371/1109 done on admission)
    Pa,CO2>6.0 kPa49 (225/456)
    ≤6.0 kPa22 (144/642)
    pH<7.3563 (141/224)
    7.35+26 (224/861)
    Pa,CO2>6.0 kPa & pH<7.3565 (128/197)
    Assisted ventilation IPPV NIPPV
    Overall3 (40/1400)
    First COPD3 (23/919)
    Re-admission3 (10/400)
    Pa,CO2>6.0 kPa7 (34/456)
    ≤6.0 kPa1 (4/642)
    PH<7.2615 (11/72)
    7.26–7.3411 (16/152)
    7.35+1 (11/861)
    Pa,CO2>6.0 kPa & pH<7.3513 (25/197)
    Medication
    Nebulized bronchodilator91 (1267/1400)
    Steroids85 (1183/1400)
    Antibiotics80 (115/1400)
    • Data presented as % (absolute fraction)

    • Sa,O2: arterial oxygen saturation

    • Pa,O2: arterial oxygen tension

    • Pa,CO2: arterial carbon dioxide tension

    • IPPV: invasive positive pressure ventilation

    • NIPPV: noninvasive positive pressure ventilation.

  • Table 4

    Continuing management

    Hospital Variation
    n (%) IQR %Range %
    PEF chart record51(710)28–685–93
    FEV1 or PEF recorded71(988)58–8426–93
    Inhaler technique assessed20(241/1218)4–260–90
    Smoking cessation advice given:
    to smokers30(134/445)14–450–75
    to exsmokers in last months11(7/64)0–00–50
    Pa,O2>7.3 kPa on air at any time33(455)18–480–78
    OP follow-up63(797/1272)50–8022–94
    Vaccination advice given5(65)0–70–21
    Pulmonary rehabilitation recommended3(39)0–30–39
    Reversibility to bronchodilator27(378)6–380–86
    Steroid reversibility tested7(96)0–110–44
    Discharge medication
    Inhaled bronchodilator64(899)48–8028–100
    Long-acting bronchodilator15(209)5–180–69
    Inhaled steroid56(779)45–6814–84
    Oral steroid57(803)47–717–80
    Home nebuliser38(536)30–480–86
    Home oxygen18(254)10–253–40
    Theophylline24(340)15–350–50
    Antibiotics35(493)29–405–78
    • Stated as concentrator in 105 cases and as cylinder in 90

    • PEF: peak expiratory flow

    • FEV1: forced expiratory volume in one second

    • Pa,O2: arterial oxygen tension

    • OP: outpatient.

  • Table 5

    Differences in the management of patients under the care of Respiratory Physicians (n=602) and nonrespiratory specialists (n=759) at the time of discharge

    Comparison madeChest Physician %Non-specialist %Chi-squared*P‐value95% CI
    Inpatient Care
    FEV1 recorded7040127.4<0.00126–36
    FEV1 %pred.492769.2<0.00117–27
    PEF chart614435.8<0.0016–17
    Inhaler technique211412.1<0.0014–13
    Smoking advice to current smokers36264.60.031–18
    Discharge Medications Prescribed
    Inhaled bronchodilator66650.20.64−4–6
    Inhaled long acting β‐agonist201216.1<0.0014–12
    Inhaled steroid61537.80.0052–13
    Oral steroid61564.30.040–11
    Home nebuliser493143.1<0.00112–23
    Home oxygen241420.9<0.0016–14
    Theophylline28227.00.0082–11
    Antibiotics36360.060.81−5–6
    Discharge plans
    Follow up arranged73460.06<0.00122–33
    Reversibility to BD332314.4<0.0014–14
    Reversibility to steroids10419.2<0.0013–9
    Vaccination advice541.20.27−1–4
    Pulmonary rehabilitation5123.3<0.0013–6
    • Comparisons made using the chi-squared test for 2×2 tables. Case numbers for inhaler technique and for smoking advice were lower due to exclusions

    • 95% CI: 95% confidence intervals

    • FEV1: forced expiratory volume in one second

    • PEF: peak expiratory flow

    • BD: bronchodilator.

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Audit of acute admissions of COPD: standards of care and management in the hospital setting
C.M. Roberts, I. Ryland, D. Lowe, Y. Kelly, C.E. Bucknall, M.G. Pearson
European Respiratory Journal Mar 2001, 17 (3) 343-349;

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Audit of acute admissions of COPD: standards of care and management in the hospital setting
C.M. Roberts, I. Ryland, D. Lowe, Y. Kelly, C.E. Bucknall, M.G. Pearson
European Respiratory Journal Mar 2001, 17 (3) 343-349;
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