Mukhtiar Zaman, Fazll Wahab, Naveed Khan, Saadla Ashraf.
Management of patients admitted with COPD exacerbation in Chest Unit and Medical Units of Khyber Teaching Hospital, Peshawar.
Pak J Chest Med Jan ;13(4):11-6.

Objective: To document and compare the management of patients admitted with COPD exacerbation in Medical Unit (MU) and Chest Unit (CU) of Khyber Teaching Hospital Peshawar. Design: Descriptive, Observational study. Place and Duration: Khyber Teaching Hospital Peshawar, from June 2006 to January 2007. Methodology: Medical records of 165 patients of CU and 123 patients of MU with the diagnosis of COPD admitted with acute exacerbation were evaluated. The information was collected on a structured Performa. The different variables are represented in mean and percentages. Results: In CU 103 out of 165 (62%) and in MU 57 out of 123 (46%) patients were males. The mode of admission was through OPD, casualty, clinic, others respectively in 69, 12, 17, 2 percent in the CU and 29, 50, 17, and 4 percent in MU patients. The mean hospital stay in CU was 4.45 days and in MU 4.81 days. In 37% male and 39% female patients of CU and in 95% male and 92% female patients of MU occupation history was not recorded. In CU 74% male and 3% female were smokers. In MU no smoking history was recorded in the female patients, while in males 34% were smokers, 17% non-smokers and in 49% no smoking history was recorded. In 98% patients of CU and 27% of MU, previous history of hospitalization was recorded. Spirometry during or prior to admission was done in 85% patients of CU and in only 07% patients of MU. In MU Oxygen saturation and Peak Expiratory Flow Rate was not recorded in a single patient while they were recorded in 84% and 85% patients of CU respectively. In MU 70(57%) patients were given 02 inhalation, out of which 68(97%) patients received uncontrolled 02 therapy. Steroid (oral/ IV) was given to 97% and 84% patients of CU and MU respectively. In CU nebulized salbutamol was given to all patients, Theophylline to 62% and Ipratropium bromide to 32% patients. In MU 84% was given Salbutamol nebulization, 4% Theophylline and 14% Ipratropium bromide. Ninety-six percent patients of CU and 92% of MU received antibiotic during hospital stay. On discharge from CU 86% patients were advised steroid inhaler, 49% Salbutamol inhaler, 41% Ipratropium bromide inhaler, 48% oral bronchodilator and 79% antibiotics, while in MU only 15% was discharged on steroid inhaler, 9% salbutamol inhaler, 12% ipratropium bromide, 43% oral bronchodilator and 53% antibiotics. Conclusion: The COPD guidelines are not followed universally in all patients but the ratio of patients managed as per guidelines is better in CU patients than MU patients.

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