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*Josefin Sundh1, Eva Österlund Efraimsson2, Christer Janson3, Scott Montgomery4,5, Björn Ställberg6, Karin Lisspers6
1 Department of Respiratory Medicine, Örebro University Hospital & School of Health and Medical Science, Örebro University, 701 85 Örebro, Sweden
2 School of Health and Social Studies, Dalarna University, 79188 Falun, Sweden (Eva Österlund Efraimsson deceased May 2013)
3 Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, 75105 Uppsala, Sweden
4 Clinical Epidemiology and Biostatistics, Örebro University Hospital & School of Health and Medical Science, Örebro University, 701 85 Örebro, Sweden
5 Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institute, 171 76 Stockholm, Sweden
6 Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, 75122 Uppsala, Sweden
Received 11 March 2013 • Accepted 18 June 2013 • Online 10 October 2013
Abstract
Background: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with lung function decline, lower quality of life, and increased mortality, and can be prevented by pharmacological treatment and rehabilitation.
Aims: To examine management including examination, treatment, and planned follow-up of COPD exacerbation visits in primary care patients and to explore how measures and management at exacerbation visits are related to subsequent exacerbation risk.
Methods: A clinical population of 775 COPD patients was randomly selected from 56 Swedish primary healthcare centres. Data on patient characteristics and management of COPD exacerbations were obtained from medical record review and a patient questionnaire. In the study population of 458 patients with at least one exacerbation, Cox regression analyses estimated the risk of a subsequent exacerbation with adjustment for age and sex.
Results: During a follow-up period of 22 months, 238 patients (52%) had a second exacerbation. A considerable proportion of the patients were not examined and treated as recommended by guidelines. Patients with a scheduled extra visit to an asthma/COPD nurse following an exacerbation had a decreased risk of further exacerbations compared with patients with no extra follow-up other than regularly scheduled visits (adjusted hazard ratio 0.60 (95% confidence interval 0.37 to 0.99), p=0.045).
Conclusions: Guidelines for examination and emergency treatment at COPD exacerbation visits are not well implemented. Scheduling an extra visit to an asthma/COPD nurse following a COPD exacerbation may be associated with a decreased risk of further exacerbations in primary care patients.
Cite as: Sundh J, Österlund Efraimsson E, Janson C, Montgomery S, Stallberg B, Lisspers K. Management of COPD exacerbations in primary care: a clinical cohort study. Prim Care Respir J 2013; Available from: URL: http://dx.doi.org/10.4104/pcrj.2013.00087
Keywords
primary care, COPD, exacerbation, management, nurse
* Corresponding author. Josefin Sundh Tel: +46 196025597, +46 702349517 Fax: +46196021865 Email: josefin.sundh@orebroll.se
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