Management of patients with COPD in the emergency department and treatment compliance with clinical guideline recommendations at discharge

BACKGROUND: Chronic obstructive pulmonary disease (COPD) exacerbations are a frequent cause of emergency department visits and are associated with high morbidity, mortality, and healthcare costs. These visits represent an opportunity to optimize patient management and align treatment with guideline recommendations, particularly regarding inhaled triple therapy. OBJECTIVES: To describe the clinical characteristics and management of COPD patients in the emergency department and to identify factors associated with inhaled triple therapy prescription at discharge. METHODS: Retrospective observational study including patients aged >18 years attended at the emergency department of the Hospital Clínico Universitario (Zaragoza, Spain) between July and December 2022, with a diagnosis of COPD exacerbation at discharge. Demographic, clinical, laboratory, and therapeutic variables were analyzed. Logistic regression identified independent predictors of inhaled triple therapy prescription at discharge. RESULTS: A total of 227 patients were included (mean age: 74.4 years; 70.9% male). Most (93.4%) had a prior COPD diagnosis, and 41.0% were already on maintenance inhaled triple therapy. At discharge, inhaled triple therapy was prescribed in 53.8% of the cases. Independent variables associated with triple therapy prescription included prior use of inhaled triple therapy (odds ratio [OR]:9.4), long-term home oxygen therapy (OR:4.3), and influenza vaccination (OR:3.1). Six months after discharge, 36.0% of patients required hospital admission for COPD exacerbation. CONCLUSIONS: One-third of COPD patients discharged from the emergency department do not receive guideline-recommended inhaled triple therapy. Interventions aimed at standardizing and optimizing emergency department management are needed to improve adherence to clinical guidelines and improve patient outcomes.