AN AUDIT OF THE MANAGEMENT OF PATIENTS ADMITTED WITH ACUTE EXACERBATION OF COPD AT A TERTIARY CARE HOSPITAL.

Abstract

Objective: To audit the management of patients admitted with acute exacerbationof chronic obstructive pulmonary disease at Pulmonology Unit KhyberTeaching Hospital (KTH), Peshawar.Patients and Methods: This was a retrospective clinical audit conducted atst th Pulmonology Unit KTH, Peshawar from 1 January 2015 till 30 April 2015. Allpatients' charts with the diagnosis of COPD exacerbation were retrieved. BTSguidelines (2010) for management of COPD were taken as standard forcomparison. Risk factors for COPD, cardinal features of COPD exacerbation,management of respiratory failure and discharge outcome were the mainvariables recorded in a structured proforma and analyzed via SPSS 19.Theresults were presented as table or graphs.Results: Of the total 119 patients with mean age of 62 (±13 SD) years, femalesconstituted 63.5%. Smoking and occupational history was recorded in 37.5%and 24% respectively. The three cardinal features of COPD exacerbation i.e.Increase in dyspnea, increase in sputum volume and purulence were documentedin 95.2%, 28.8% and 17.3% respectively. Oxygen saturation wasrecorded in all patients, showing Spo2 <92% in two third (67.3%), in whichArterial blood gases were obtained in 90% cases. Controlled oxygen wasprescribed to 90% of patients with type 2 respiratory failure. The exactdiagnosis was documented in 29.3% only. Nebulized bronchodilators,intravenous steroids and intravenous antibiotics were prescribed to >90% ofpatients. Most of the patients (84.5%) were discharged on home treatmentwhile in-hospital mortality was 13.68%.Conclusion: Smoking status, occupational history and the three cardinalfeatures of COPD exacerbation were not documented in more than half of theclinical notes. The management of COPD exacerbation and respiratory failurewas parallel with BTS standards in majority; however the exact diagnosis wasnot documented in nearly two third of the cases.