National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993–2005

Authors

  • Chu-Lin Tsai MD, MPH,

    1. From the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health (CLT, CAC), Boston, MA; and Johns Hopkins University School of Medicine (JAS), Baltimore, MD.
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  • Justin A. Sobrino BS,

    1. From the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health (CLT, CAC), Boston, MA; and Johns Hopkins University School of Medicine (JAS), Baltimore, MD.
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  • Carlos A. Camargo Jr MD, DrPH

    1. From the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health (CLT, CAC), Boston, MA; and Johns Hopkins University School of Medicine (JAS), Baltimore, MD.
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  • The project was supported by an unrestricted grant from GlaxoSmithKline (Research Triangle Park, NC).

  • Conflict of interest statement: Dr. Camargo has received financial support (research grants, consulting, lectures) in the past 5 years from Altana, AstraZeneca, Aventis, Aventis Pasteur, Boehringer Ingelheim, Dey, GlaxoSmithKline, MedImmune, Merck, Novartis, Pfizer, Respironics, and Schering Plough. The other authors have no conflicts of interest to disclose.

Dr. Chu-Lin Tsai; e-mail: ctsai2@partners.org. Reprints will not be available.

Abstract

Objectives:  Little is known about recent trends in U.S. emergency department (ED) visits for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or about ED management of AECOPD. This study aimed to describe the epidemiology of ED visits for AECOPD and to evaluate concordance with guideline-recommended care.

Methods:  Data were obtained from National Hospital Ambulatory Medical Care Survey (NHAMCS). ED visits for AECOPD, during 1993 to 2005, were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Concordance with guideline recommendations was evaluated using process measures.

Results:  Over the 13-year study period, there was an average annual 0.6 million ED visits for AECOPD, and the visit rates for AECOPD were consistently high (3.2 per 1,000 U.S. population; Ptrend = 0.13). The trends in the use of chest radiograph, pulse oximetry, or bronchodilator remained stable (all Ptrend > 0.5). By contrast, the use of systemic corticosteroids increased from 29% in 1993–1994 to 60% in 2005, antibiotics increased from 14% to 42%, and methylxanthines decreased from 15% to <1% (all Ptrend < 0.001). Multivariable analysis showed patients in the South (vs. the Northeast) were less likely to receive systemic corticosteroids (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4 to 0.9).

Conclusions:  The high burden of ED visits for AECOPD persisted. Overall concordance with guideline-recommended care for AECOPD was moderate, and some emergency treatments had improved over time.

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