Recommendations for Improving Discharge-Related Care Following a COPD Exacerbation: An Expert Panel Consensus with Emphasis on Low- and Middle-Income Countries

Adrian Rendon,1 Susana Luhning,2 Philip Bardin,3 Carlos Andrés Celis-Preciado,4 Moustafa El Shazly,5 Mark Cohen-Todd,6 Ahmad Izuanuddin Ismail,7 Majdy Idrees,8 Seong Yong Lim,9 Pin-Kuei Fu,10 Terence Seemungal,11 Nurdan Köktürk,12 John R Hurst13 1Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Monterrey, México; 2Pneumologist, Hospital Nacional de Clínicas, Universidad Nacional de Córdoba, Córdoba, Argentina; 3Australia Monash Lung, Sleep, Allergy and Immunology, Melbourne, Victoria, Australia; 4Pulmonary Unit, Internal Medicine Department, Hospital Universitario San Ignacio, Bogota, Colombia; 5Chest Department, Kasr el-Aini Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt; 6Hospital Centro Médico, Guatemala City, Guatemala; 7Cardiac, Vascular and Lung Research Institute (CaVaLRI), Universiti Teknologi MARA, Selangor, Malaysia; 8Department of Medicine, Division of Pulmonary Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 9Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 10Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; 11Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; 12Department of Pulmonary and Critical Care Medicine, School of Medicine, Gazi University, Ankara, Turkey; 13UCL Respiratory, University College London, Royal Free Campus, London, NW3 2QG, UKCorrespondence: Adrian Rendon, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Monterrey, México, Email [email protected]: Exacerbations of chronic obstructive pulmonary disease (COPD) continue to place a considerable disease and financial burden on both patients and healthcare systems, particularly in low- and middle-income countries (LMICs). Therefore, preventing future exacerbations remains a key treatment goal. However, gaps remain in the standard of COPD care following exacerbations, despite the availability of evidence-based recommendations providing guidance on discharging patients from hospital or emergency department (ED) after a COPD exacerbation. To better understand these gaps in clinical practice, an advisory board meeting of 13 international pulmonologists was convened in September 2022, with the principal objective to formulate and recommend an evidence-based hospital discharge protocol following a COPD exacerbation, with a particular focus on LMICs. Based on identified gaps in COPD care, recommendations for alleviating the burden of exacerbations were proposed, which could be delivered as a discharge protocol for implementation in hospitals and/or ED. Following a review of the available clinical evidence, including an online survey of 11 pre-meeting questions and 5 additional questions discussed during the meeting, the key unmet needs identified by the experts included poor integration of standardized protocols in routine clinical practice, failure to ensure consistent delivery of post-discharge care, and lack of efficiently functioning healthcare systems. A protocol was formulated for delivery as part of a disease management program involving an interdisciplinary approach and a care bundle, aiming to address gaps in discharge-related care by determining the likelihood of readmission and optimizing maintenance treatment plans based on assessment of symptoms and future exacerbation risk. This can provide holistic care following hospital/ED discharge and personalized treatment plans by advocating referral to a specialist. To ensure wide-ranging uptake, implementation of a discharge protocol will need to be tailored to local healthcare settings by conducting feasibility studies, standardizing clinical pathways and healthcare policies, and engaging relevant stakeholders.Keywords: chronic obstructive pulmonary disease, exacerbation, discharge protocol, hospital, emergency department