• J Considine, M Botti, and S Thomas.
• School of Nursing, Deakin University-Northern Health Clinical Partnership, Melbourne, Victoria, Australia. julie.considine@deakin.edu.au
• Intern Med J. 2011 Jan 1;41(1a):48-54.

BackgroundEmergency departments (ED) play a key role in management of exacerbation of chronic obstructive airways disease (COPD). Current guidelines for management of exacerbation of COPD showed highest levels of evidence (Level A and B) were related to use of medications and non-invasive positive pressure ventilation (NIPPV).AimsThe aim of this study was to examine compliance with high level evidence for management of exacerbation of COPD during the first 4 h of ED care.MethodsA retrospective medical record audit was conducted at four public and one private ED in Melbourne, Australia. Participants were adult patients with COPD presenting to the ED with a primary complaint of shortness of breath from July 2006 to July 2007. Outcome measures were compliance with evidence-based recommendations regarding use of bronchodilators, methylxanthines, steroids and NIPPV.ResultsOf 273 patients in this study, 72.4% received short-acting beta-agonist bronchodilators, 37.8% received an inhaled short-acting anticholinergic medication and 56.6% received systemic steroid therapy. NIPPV was used in 21 patients, 15 of whom had documentation of acidosis and/or hypercapnia).ConclusionsThere was variation in the use of high level evidence for the ED management of exacerbation of COPD. The highest rate of compliance was non-use of methylxanthines and the greatest deficit was poor compliance with evidence related to NIPPV. There was also scope for improvement in the use of bronchodilators and systemic steroids.© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

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