COPD Exacerbation
Conditions
Keywords
COPD, exacerbation, Prospective, Observational, Professional practices guidelines
Brief summary
Chronic Obstructive Pulmonary Disease (COPD) is a public health problem responsible for high mortality rate and significant costs for society. The disease evolution is punctuated by exacerbations worsening the health state of patients. Many guidelines of care procedures have been written but many disparities persist in medical practices. This pilot prospective observational study is an overview of current local practices in the university health center of Grenoble Alpes and it is the first step towards developing a regional observatory in order to standardize and improve patient cares. The primary outcome is to compare the international guidelines to the local practices regarding the prescription of key treatments of exacerbation, especially antibiotics.
Interventions
None listed
Sponsors
University Hospital, Grenoble
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient older than 18 years (included) * Known or suspected Chronic Obstructive Pulmonary Disease * Admitted for COPD exacerbation in emergency department or pneumology department or intensive care unit of university health center of Grenoble Alpes during the period of data collection.
Exclusion criteria
* opposition to participate at the study * Patients under the law
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of antibiotics prescriptions following the guidelines in COPD exacerbation. | up to 30 days | Adherence to guidelines regarding antibiotics prescription in COPD exacerbation that is justified by : * sputum purulence * severe symptoms * severe comorbidities * pneumonia |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of hospitalization of patients following the guidelines in COPD exacerbation. | up to 30 days | Adherence to guidelines regarding hospitalization criteria in COPD exacerbation that are : * severe symptoms * respiratory failure * failure of first treatments * severe comorbidities * deficient social environment * patient older than 85 years old * baseline dyspnea around 4 to 5 in Modified Medical Research Council Dyspnea Scale (mMRC scale) Adherence to guidelines regarding criteria for intensive care unit hospitalization in COPD exacerbation that are : * severe dyspnea not responding to first treatments * neurologic troubles * persistant hypoxemia despite oxygen administration or Non Invasive Ventilation. * respiratory acidosis despite Non Invasive Ventilation * need for invasive mechanical ventilation * hemodynamic instability and need for aminergic support |
| Percentage of non invasive ventilation following the guidelines in COPD exacerbation. | up to 30 days | Adherence to guidelines regarding criteria for non invasive ventilation in COPD exacerbation that are : * respiratory acidosis * signs of respiratory failure * hypoxemia despite oxygen administration * absence of medical contraindications |
| Percentage of invasive ventilation following the guidelines in COPD | up to 30 days | Adherence to guidelines regarding criteria for invasive ventilation in COPD exacerbation that are : * failure of non invasive ventilation * medical contraindications for non invasive ventilation * cardiac arrest * neurologic troubles needing sedation * pernicious vomiting * ineffective coughing |
| Percentage of corticosteroids prescriptions following the guidelines in COPD exacerbation. | up to 30 days | Adherence to guidelines regarding corticosteroids prescription in COPD exacerbation that is : * not a systematic prescription * if needed, it is 30 to 40mg per day of prednisone equivalent and 5 to 7 days maximum |
| Percentage of follow-up management after COPD exacerbation following the guidelines | up to 30 days | Adherence to guidelines regarding follow-up management after COPD exacerbation that is : * adherence to discharge criteria * first medical evaluation one week after discharge * early specialized follow-up into four to six weeks after discharge |
| Frequency of advance directives. | at day 0 | Frequency of advance directives written by patients with COPD |
| Percentage of minimal medical examinations following the guidelines in COPD exacerbation. | up to 30 days | Adherence to guidelines regarding the prescription of minimal medical examinations in COPD exacerbation that is : * complete blood count, kidney function, glucose level * blood gases * chest radiography * electrocardiogram * bacteriological sputum examination only if antibiotic-resistant germ infection is suspected. |
Countries
France
Outcome results
None listed