Characteristics of emergency department patients with confirmed diagnoses of chronic obstructive pulmonary disease vs patients with respiratory symptoms and a suspected diagnosis.

Abstract

Objective: To describe differences in patient characteristics and case management between patients attended in emergency departments (EDs) with confirmed diagnoses of chronic obstructive pulmonary disease (COPD) vs those with respiratory symptoms in whom COPD is suspected.

Methods: Prospective multicenter observational study of patients registered in a multipurpose database between November 14, 2022, and May 14, 2023, in 14 emergency departments in the public hospital system of Castile-Leon. We included patients aged 40 years or older with confirmed COPD or suspected COPD. Variables analyzed were patient characteristics, clinical presentation, and management of the emergency episode.

Results: Of a total of 1179 patients, 931 (78.9%) had diagnosed COPD and 248 (21.1%) had suspected COPD. The median (interquartile range) age was 76 years (68-83 years) and 305 (25.87%) were women. Variables related to suspected COPD were age between 40 and 65 years (odds ratio [OR], 0.46; 95% CI, 0.26-0.65) and female sex (OR,0.57; 95% CI, 0.42-0.77). Patients with diagnosed COPD had higher Charlson comorbidity scores (OR, 1.93; 95% CI,1.42-2.63), and more of them were using inhalers (OR, 3.43; 95% CI, 2.57-4.61). Admission to a respiratory care ward (OR, 1.39; 95% CI, 1.97-3.01) and need for noninvasive mechanical ventilation (OR, 3.21; 95% CI, 1.27-10.71) were more common in patients with diagnosed COPD. However, no differences were observed in the frequency of hospitalization overall or 30-day mortality.

Conclusions: Clinical characteristics and management of emergency care differ between patients with confirmed vs suspected COPD. Patients with suspected COPD had more limited access to certain diagnostic, therapeutic, and follow-up resources.