A snapshot of chronic obstructive airways disease in Australian emergency departments

Objectives: To characterise emergency department (ED) attendances for chronic obstructive airways disease (COAD) by patient demographics and severity, to determine treatment and disposition of patients and to determine use of diagnostic tests and treatment provided to different severity groups. A secondary aim was to compare treatment given to established treatment guidelines. Methods: Prospective, observational cohort study of patients who presented to nine Australian ED with a primary diagnosis of acute exacerbation of COAD in October 2002. Information collected included demographics, duration of symptoms, comorbidities, assessment findings, severity, treatment, disposition, tests, in-hospital mortality and length of stay. Results: A total of 137 patients were studied. Two-thirds (65%) of the group were male, and most (90%) were aged greater than 60 years. COAD severity was mild in 11%, moderate in 30% and severe in 59%, and 23% were receiving home oxygen therapy. As anticipated, patients with severe COAD were more likely to be admitted to hospital (mild: moderate: severe = 13%: 68%: 99%; p < 0.0001) and to require ventilatory support (0%: 0%: 23%; p < 0.002). There was under-utilisation of corticosteroids and antibiotics in the moderate and severe groups, and only 35% of the group had received influenza vaccination within the past year. Conclusion: This study showed that adherence to best practice guidelines with respect to the use of corticosteroids and antibiotics for patients who presented to the ED with COAD was sub-optimal, as was the prevalence of prior influenza vaccination. Other aspects of treatment and investigation were consistent with available evidence. Efforts to address these deficiencies should be developed.