Initial management and investigations in acute exacerbation of chronic obstructive pulmonary disease: an audit

Courtney J. Lawson



Chronic obstructive pulmonary disease (COPD) affects three
million people in England and Wales, including more than 5% of the over 65s. It is the country’s fifth biggest killer, at 30,000 deaths per year. Severeexacerbations are the second commonest cause of emergency admissions,with 15% three-month mortality.


The clinical practice of the Emergency Department (ED) on the Isleof Man was compared with UK best-practice guidelines regarding the initial management and investigations in acute exacerbation of COPD (AECOPD).The National Institute for Health and Care Excellence (NICE) CG101 provides guidance for managing AECOPD. The evidence underpinning these guidelines was appraised and a retrospective audit of 40 patients in the ED was conducted.


Compliance to the use of air-driven nebulisers was uncertain due to insufficient documentation. Adequate arterial blood gas (ABG): 19 (47.5%). Chest radiograph (CXR): 39 (97.5%). Electrocardiogram (ECG): 37 (92.5%).Full blood count (FBC) plus urea and electrolytes (U&Es): 38 (95%). All pyrexial
patients received blood cultures. Documentation of theophylline use was poor and patients on theophylline did not have levels measured.


The initial management and investigations of AECOPD in the ED could be improved through research on nebuliser use, better documentation and implementation of departmental guidance for clinical decision-making.

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