Appendix 6

Uptake and impact of guidelines for exacerbations

Although there are many COPD guidelines around the world, there has been little evaluation of their uptake into clinical practice, or their impact on clinical outcomes.  A study of the compliance to COPD-X (Gerber 2016) recommendations in 381 COPD patients attending the EDs of two hospitals within one local Australian health service, has demonstrated moderately satisfactory results, with compliance to individual recommendations of the order of 74-90%, and to the whole list of recommendations of 49%, indicating  some room for further improvement.  Highest levels of compliance were seen in the most severe COPD cases.  This study did not show a reduction in LOS with greater compliance, however this analysis did not adjust for severity.  A European study found that hospitalised COPD patients with an exacerbation received on average only 41% of key diagnostic, pharmacological and non-pharmacological recommendations from clinical guidelines, including low uptake of provision of smoking cessation advice, inhaler technique education and referral to pulmonary rehabilitation (Seys 2017).

An audit of COPD patients in the Outpatient respiratory clinics of 59 Spanish hospitals (Calle Rubio 2017) demonstrated that clinical practice, at least as recorded in the case notes, fell well short of recommendations in GOLD and Spanish national guidelines for COPD.