Management of chronic obstructive pulmonary disease exacerbations at the Nasser Medical Complex: a clinical audit

Abstract Background The frequency and severity of chronic obstructive pulmonary disease (COPD) exacerbations are the most important determinants of prognosis in COPD. The aim of this study was to assess the management of patients presenting with COPD exacerbations at the Nasser Medical Complex in the Gaza Strip and to compare the management with the Global Initiative for Chronic Obstructive Lung Disease guidelines (GOLD 2015). Methods We reviewed the medical records of all patients admitted to Nasser Medical Complex and diagnosed with COPD exacerbation between Jan 1, 2014, and Dec 31, 2016. Clinical practice was compared with GOLD guidelines. Ethical approval was obtained from the General Directorate of Human Resources. Findings 55 patient records were reviewed. The mean age was 66·4 years (SD 8·5), and 54 (98%) patients were male. All patients received inhaled bronchodilators. 36 (65%) patients received short-acting β agonists (SABA), 43 (78%) received short-acting muscarinic agonists (SAMA), 13 (24%) received long-acting muscarinic agonists (LAMA), one (2%) received long-acting beta-agonists (LABA), and 22 (40%) received both SABA and SAMA. 53 (96%) patients received systemic corticosteroids. 43 (78%) patients took more than the recommended 40 mg prednisolone daily. Only 12 (22%) patients received prednisolone as the recommended 5 day treatment course, whereas most patients received a shorter course. Other treatments included oxygen (51 [93%] patients), antibiotics (55 [100%]), antiviral medication (three [6%]), and theophylline (two [4%]). Interpretation Overall adherence to guidelines was moderately good. All patients received antibiotics, and most patients received oxygen, which are both recommended for all patients. Less useful therapies were rarely prescribed. However, more patients received SAMA than SABA, although SABA is more effective and therefore the first-line treatment for COPD exacerbation. The dose of the most prescribed drug (prednisolone) exceeded the recommended dose. Generally, awareness and adherence to clinical guidelines needs to be improved as part of the fostering of evidence-based medicine. Documentation was of a very poor standard and must be improved to develop a meaningful audit culture. Funding None.