Hussain Ahmad, Mukhtiar Zaman.
An audit of the management of patients admitted with acute exacerbation of copd at a tertiary care hospital.
Pak J Chest Med Jan ;21(2):68-75.

Objective: To audit the management of patients admitted with acute exacerbation of chronic obstructive pulmonary disease at Pulmonology Unit Khyber Teaching Hospital (KTH), Peshawar. Patients and Methods: This was a retrospective clinical audit conducted at Pulmonology Unit KTH, Peshawar from 1 January 2015 till 30 April 2015. All patients' charts with the diagnosis of COPD exacerbation were retrieved. BTS guidelines (2010) for management of COPD were taken as standard for comparison. Risk factors for COPD, cardinal features of COPD exacerbation, management of respiratory failure and discharge outcome were the main variables recorded in a structured proforma and analyzed via SPSS 19.The results were presented as table or graphs. Results: Of the total 119 patients with mean age of 62 (±13 SD) years, females constituted 63.5%. Smoking and occupational history was recorded in 37.5% and 24% respectively. The three cardinal features of COPD exacerbation i.e. Increase in dyspnea, increase in sputum volume and purulence were documented in 95.2%, 28.8% and 17.3% respectively. Oxygen saturation was recorded in all patients, showing Spo2 <92% in two third (67.3%), in which Arterial blood gases were obtained in 90% cases. Controlled oxygen was prescribed to 90% of patients with type 2 respiratory failure. The exact diagnosis was documented in 29.3% only. Nebulized bronchodilators, intravenous steroids and intravenous antibiotics were prescribed to >90% of patients. Most of the patients (84.5%) were discharged on home treatment while in-hospital mortality was 13.68%. Conclusion: Smoking status, occupational history and the three cardinal features of COPD exacerbation were not documented in more than half of the clinical notes. The management of COPD exacerbation and respiratory failure was parallel with BTS standards in majority; however the exact diagnosis was not documented in nearly two third of the cases.

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