Management of acute exacerbation of COPD in tertiary care hospital of Peshawar: A retrospective clinical audit

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of global morbidity and mortality, with acute exacerbations significantly worsening patient outcomes. These exacerbations often lead to hospitalizations and increased healthcare costs. Proper management, guided by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, is essential to improving care. However, real-world adherence to these recommendations can vary. Objective: To assess how acute COPD exacerbations were handled at a tertiary care hospital of Peshawar.  Methodology: In the emergency department of Hayatabad Medical Complex Peshawar, between November 2021 and December 2023, we retrospectively examined clinical data of patients presenting with acute exacerbations of COPD. The management was assessed in light of the GOLD 2019 report's and earlier audits' recommendations. Results: Total 170 patients (mean age 73 years, range 41–95 years, 54% male) were included. GOLD risk group (A-D) was only documented in 39% of the cases. At the time of presentation, 74% of the patients had their respiratory rate evaluated, and 69% had their blood gas analysis done. In all, 95% of the patients had chest imaging performed. Short-acting bronchodilators were used as initial symptomatic management in 56% of cases. Among them, 92% had implemented systemic steroid therapy. Conclusion: The GOLD guidelines were not fully followed, particularly in relation to non-invasive breathing, early symptomatic treatment, and severity assessment. These findings highlight the significance of periodic practice revisions on a regular basis, which may raise practitioners' knowledge and enhance the standard of COPD care in the long run.