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Assessment of adherence to practice guidelines for managing exacerbation of chronic obstructive pulmonary disease in the emergency department

Carrillo Rivas M, García-Castrillo Riesgo L, Agüero Balbín R, Arnaiz García AM, Saro Gutierrez G, Andrés Gómez M

Servicio de Urgencias, Servicio de Neumología, Servicio de Medicina Interna-Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, Spain.

This study aimed to describe clinical practice in terms of the degree of adherence to
practice guidelines for managing chronic obstructive pulmonary disease (COPD) in a
hospital emergency department. We reviewed the records of 352 patients with COPD
treated over a period of 1 year. Blood pressure was recorded in 92% of the cases, heart
rate in 74.7%, respiratory frequency in 71.9%, arterial blood oxygen saturation in
88.4%, the presence of breathlessness at rest in 25.3%, and accessory muscle
recruitment in 13.4%. In cases for which it was possible to assess antibiotic therapy,
these drugs were administered without adherence to guideline indications in 78.2%,
and only 117 of the 215 patients (54%) with serious exacerbation received systemic
corticosteroids. We conclude that the records reveal low adherence to recommendations
for recording the signs required to apply practice guidelines for the management of
COPD. It is therefore necessary to find tools that improve adherence to the
recommended clinical pathways.

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