• Josefin Sundh, Eva Österlund Efraimsson, Christer Janson, Scott Montgomery, Björn Ställberg, and Karin Lisspers.
• Department of Respiratory Medicine, Örebro University Hospital & School of Health and Medical Science, Örebro University, 701 85 Örebro, Sweden.
• Prim Care Respir J. 2013 Dec 1;22(4):393-9.

BackgroundChronic obstructive pulmonary disease (COPD) exacerbations are associated with lung function decline, lower quality of life, and increased mortality, and can be prevented by pharmacological treatment and rehabilitation.AimsTo examine management including examination, treatment, and planned follow-up of COPD exacerbation visits in primary care patients and to explore how measures and management at exacerbation visits are related to subsequent exacerbation risk.MethodsA clinical population of 775 COPD patients was randomly selected from 56 Swedish primary healthcare centres. Data on patient characteristics and management of COPD exacerbations were obtained from medical record review and a patient questionnaire. In the study population of 458 patients with at least one exacerbation, Cox regression analyses estimated the risk of a subsequent exacerbation with adjustment for age and sex.ResultsDuring a follow-up period of 22 months, 238 patients (52%) had a second exacerbation. A considerable proportion of the patients were not examined and treated as recommended by guidelines. Patients with a scheduled extra visit to an asthma/COPD nurse following an exacerbation had a decreased risk of further exacerbations compared with patients with no extra follow-up other than regularly scheduled visits (adjusted hazard ratio 0.60 (95% confidence interval 0.37 to 0.99), p=0.045).ConclusionsGuidelines for examination and emergency treatment at COPD exacerbation visits are not well implemented. Scheduling an extra visit to an asthma/COPD nurse following a COPD exacerbation may be associated with a decreased risk of further exacerbations in primary care patients.

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