Characteristics of patients with chronic obstructive pulmonary disease (COPD) discharged from the emergency department – Improving the care pathway for acute exacerbations of COPD

Introduction: This study characterized COPD-patients attending an Emergency Department (ED) who are discharged. Methods: Retrospective records-review of COPD-patients discharged from ED (04/2009-03/2010) included demographics, symptoms, spirometry, treatment (pre-ED and discharge), ED attendances/hospital admissions & deaths in the subsequent 90 days. Results: 49/53 episodes coded COPD-ED-discharges in 45 patients were compatible with AECOPD (11% of total 387 AECOPD presentations). 30/49 presented outside 9-5, Monday–Friday. Obstructive spirometry was recorded for 28/45: mean (SD) FEV1 1.21 (0.55)litres. Patients on GP-COPD registers included 2 with restrictive spirometry; 2 had no spirometry; 11 a new COPD diagnosis. Symptoms were increased breathlessness (42/47), cough (38/48) & changing sputum (15/48). Mean (range) symptom duration was 4 (0-28)days (n=40), but <1 day in 21/40. 8/46 started corticosteroids and 10/46 antibiotics before attending ED. At discharge, 34/49 received/continued corticosteroids; 16/49 antibiotics. 2 patients died. 15/49 episodes resulted in hospital admission within 90 days, 6/15 within 2 weeks. Conclusions: Patients discharged from ED with AECOPD account for 11% of COPD hospital presentations ( 50% presented within 24h of symptoms, 60% outside working-hours. In >20%, diagnosis was not confirmed by spirometry. Only 20% started exacerbation treatment before attending; 30% not given corticosteroids on discharge. Readmission rates were high despite moderately severe COPD. Optimal management of ED-COPD discharges should include corticosteroids, followed by GP-review within 7 days.