Respiratory clinicians’ attitudes to offering ‘rescue packs’ to patients discharged after COPD exacerbation

Rescue packs for COPD exacerbations, consisting of a course of antibiotics and steroids, have become part of self-management strategies for many patients living with COPD. Currently, in the UK rescue packs are guideline-recommended but not routinely offered on hospital discharge. They are, however, commonly prescribed by primary care teams. This study examined hospital-based respiratory clinicians’ attitudes to offering patients rescue packs following hospitalisation for COPD exacerbations to better understand clinicians' concerns. We conducted online interviews with over 30 clinicians (respiratory consultants and specialist nurses) in over 15 UK hospitals to understand variation in practice around, and attitudes towards, offering rescue packs to discharged COPD patients. Clinicians’ attitudes to offering rescue packs to discharged COPD patients were a contradictory mixture of concerns and recognition of potential benefits. Concerns included antimicrobial resistance, individual overuse of antibiotics and potential side effects of steroids, especially in patients with poorer understanding of their own condition, with lower self-management skills, or who found it difficult to access primary care. Recognised benefits included the potential to prevent future exacerbations, empowering patients by supporting COPD self-management, and circumventing the difficulties of securing an urgent GP appointment. There was a consensus that supporting patients in self-management of COPD was key to effective care. Given the increasing role of self-management for patients living with COPD, it is central to ensure that patients are able to appropriately use rescue packs.