Hospital discharge protocol for patients with chronic obstructive pulmonary disease: expert consensus from India

Chronic obstructive pulmonary disorder (COPD) is a significant health challenge in India, mainly attributed to smoking, air pollution, and biomass fuel exposure. Severe COPD is associated with frequent hospitalization due to recurring exacerbations, leading to increased healthcare utilization and economic burden, and a higher risk of cardiovascular events and mortality. Preventing exacerbations is key to slowing disease progression, as each exacerbation worsens lung function and increases the risk of future exacerbations. Evidence suggests that implementing evidence-based discharge care bundles may reduce hospital readmissions and improve patient outcomes. A virtual advisory board meeting involving 7 leading experts from pulmonary medicine and cardiology specialties was convened in June 2024 to gain insights into the current unmet needs in managing COPD exacerbations, particularly focused on discharge protocols. Targeted, nonsystematic literature searches using MEDLINE databases focused on local or national discharge protocols/guidelines for COPD patients’ post-exacerbation, their clinical implementation, and identified challenges and gaps encountered following hospital discharge. The panel proposed a standardized COPD discharge protocol based on local clinical practices for uniform implementation and uptake across all healthcare settings in India. Experts recommended prioritizing the accessible and affordable interventions including smoking cessation, education of patients and caregivers, medication reconciliation, and referral to home-based pulmonary rehabilitation programs.