What happens to COPD patients before an admission with exacerbation?

Aim: To obtain patient-generated data relating to the management of their chronic obstructive pulmonary disease (COPD) in Primary Care before hospitalisation with exacerbation.

Background: Previous audits of COPD have shown high rates of hospital admission and readmission. There is significant interest in understanding the reasons so that useful preventative strategies may be developed.

Managing patients with COPD exacerbation: does age matter?

Introduction: there is little information about the relationship between age and management of COPD exacerbation (AECOPD), although older persons are known to be at a greater risk of hospital admission.

Methods: we have investigated responses from the clinical and patient questionnaire elements of the 2008 UK COPD audit, splitting the data into age decile.

Results: age ranged from 27 to 102.

Co-morbidities and 90-day outcomes in hospitalized COPD exacerbations.

COPD exacerbations resulting in hospitalization are accompanied by high mortality and morbidity. The contribution of specific co-morbidities to acute outcomes is not known in detail: existing studies have used either administrative data or small clinical cohorts and have provided conflicting results. Identification of co-existent diseases that affect outcomes provides opportunities to address these conditions proactively and improve overall COPD care.

A randomized trial of peer review: the UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project: three-year evaluation.

Rationale: Peer review has been widely used within the National Health Service to facilitate health quality improvement but evaluation has been limited particularly over the longer-term. Change within the National Health Service (NHS) can take a prolonged period--1-2 years--to occur. We report here a 3-year evaluation of the largest randomized trial of peer review ever conducted in the UK.

Current and planned palliative care service provision for chronic obstructive pulmonary disease patients in 239 UK hospital units: comparison with the gold standards framework.

Patients with chronic obstructive pulmonary disease report a symptom burden similar in magnitude to terminal cancer patients yet service provision and access has been reported as poor. In the absence of a specific national chronic obstructive pulmonary disease service framework the gold standards framework might support service developments. We surveyed 239 UK acute hospital units admitting chronic obstructive pulmonary disease patients, comprising 98% of all acute trusts, about their current and planned provision for palliative care services.

Exploring the outcomes and implications of the latest national COPD audit.

Publication of the clinical strategy for COPD is expected at the end of the year and it is anticipated that this will provide a structure to improve management of the condition. The latest national COPD audit has shown that although services have improved since the last audit in 2003, there are key areas in COPD management that need to be improved. This article analyses the results of this audit and the implications for practice.

Introducing the national COPD resources and outcomes project.

Background: We report baseline data on the organisation of COPD care in UK NHS hospitals participating in the National COPD Resources and Outcomes Project (NCROP).

Methods: We undertook an initial survey of participating hospitals in 2007, looking at organisation and performance indicators in relation to general aspects of care, provision of non-invasive ventilation (NIV), pulmonary rehabilitation, early discharge schemes, and oxygen. We compare, where possible, against the national 2003 audit.