Islamic University of Gaza, Palestinian Territory
Background: The frequency and severity of COPD exacerbations are the most important determinants for prognosis in COPD. This study assesses the management of patients presenting with COPD exacerbation, comparing this to the Global Initiative for Chronic Obstructive Lung Disease Guideline (GOLD 2015). Methods: Medical records of all patients admitted to Nasser Medical Complex from 2014 to 2016 with a diagnosis of COPD exacerbation, were reviewed. Clinical practice was compared with GOLD. Ethical approval was obtained from the General Directorate of Human Resources. Results: In total, 55 patients were identified f. The mean age was 66.4 years and 98.2% were male. All patients received inhaled bronchodilators, of these 64.4% received short acting beta-agonists (SABA), 78% short-acting muscarinic agonists (SAMA), 23.6% long-acting muscarinic agonists (LAMA), 1.8% long-acting beta-agonists (LABA) and 40% both SABA and SAMA. A total of 96.4% patients received systemic corticosteroids. 78.2% of patients took >40mg prednisolone daily. Only 21.8% received Prednisolone as the recommended five-day-course, while the majority received a shorter course. Other treatments included oxygen (92.7%), antibiotics (100%), antiviral medication (5.5%) and theophylline (3.6%). Interpretation: Overall adherence to guidelines was moderately good. All patients received antibiotics and 94.7% oxygen, which are both recommended for all patients. Less useful therapies were rarely prescribed. However, more patients received SAMA than SABA, although SABA is more effective and therefore the first line treatment for COPD exacerbation. 96.4% of patients received systemic corticosteroids. However, the mostly prescribed dose (75mg Prednisolone) exceeds the recommendation, which is 40mg for 5 days. Generally, awareness and adherence to clinical guidelines has to be improved. This goes hand in hand with fostering evidence based medicine. As other audit projects, this one also found documentation to be of a very poor standard. This is in urgent need of improvement across Gaza, in order to nurture a meaningful audit culture.