Management of chronic obstructive pulmonary disease in patients admitted to a tertiary care centre for exacerbation of their disease.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with an accelerated decline in lung function and a significant decrease in health status. Maintenance therapy with respiratory medications can reduce the risk of such exacerbations. OBJECTIVE: To determine whether respiratory maintenance medications were being prescribed in accordance with the 2007 COPD guidelines of the Canadian Thoracic Society for patients admitted to hospital for acute exacerbation of COPD. METHODS: A chart review was conducted for admissions to the Centre hospitalier universitaire de Sherbrooke, in Sherbrooke, Quebec, for acute exacerbation of COPD (according to diagnostic codes in the International Statistical Classification of Diseases and Related Health Problems, 10th revision) between January 1, 2008, and January 31, 2011. Data were extracted from patients' medical charts concerning respiratory medications prescribed before the admission, during the hospital stay, and at discharge. RESULTS: A total of 846 hospital admissions involving 561 patients were reviewed. In almost 70% of admissions for which data were available on respiratory medications prescribed before the admission, during the hospital stay, and at discharge (238/341 [69.8%]), a combination of 3 medications was prescribed at discharge: tiotropium, a long-acting ß(2) agonist, and an inhaled corticosteroid. For more than 80% of the admissions, a prescription for at least one inhaled long-acting bronchodilator was documented both on admission and at discharge. Few patients had a prescription for inhaled corticosteroid without long-acting ß(2) agonist, but the number of admissions with a prescription for regular use of systemic corticosteroids increased at discharge. CONCLUSIONS: Respiratory medications were generally prescribed in accordance with Canadian COPD guidelines, but improvements could be made regarding use of the combination of tiotropium, long-acting ß(2)agonist, and inhaled corticosteroid, as well as long-term use of systemic corticosteroids.