Background: The European COPD Audit initiated by the European Respiratory Society (ERS) evaluated the management of hospital admissions due to exacerbation of chronic obstructive pulmonary disease (COPD) in several European countries. Data on the treatment of severe acute exacerbations of COPD (AECOPDs) in Switzerland are scarce. Objectives: In light of the GOLD 2010 guidelines, this work aims to examine the quality of care for AECOPD and to provide specific recommendations for the management of severe AECOPD in Switzerland. Methods: A total of 295 patients requiring hospital admission to 19 Swiss hospitals due to exacerbation of COPD during a predefined 60 days in 2011 were included in the study. We compared the Swiss data to the official GOLD 2010 recommendations and to the results of the other European countries. Results: Approximately 43% of the Swiss patients with severe AECOPD were current smokers at hospital admission, compared to 33% of the patients in other European countries (p < 0.001). In Switzerland and in Europe, spirometry data were not available for most patients at hospital admission (65 and 60%, respectively; p = 0.08). In comparison to other European countries, antibiotics were prescribed 14% less often in Switzerland (p < 0.001). Only 79% of the patients in the Swiss cohort received treatment with a short-acting bronchodilator at admission. Conclusions: Considering the overall high standard of health care in Switzerland, in light of the GOLD 2010 guidelines we are able to make 7 recommendations to improve and standardize the management of severe AECOPD for patients treated in Switzerland.

Keywords:
Chronic obstructive pulmonary disease, Switzerland, Exacerbation, GOLD, ERS, Europe, Audit, Therapy, Bundle, Recommendations
1.
WHO: Chronic obstructive pulmonary disease (COPD). 2016. http://www.who.int/topics/chronic_obstructive_pulmonary_disease/en/.
2.
GBD 2015 Mortality and Causes of Death Collaborators: Global, regional, and national life expectancy, all-cause mortality and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1459-1544.
3.
Russi EW, Karrer W, Brutsche M, Eich C, Fitting JW, Frey M, Geiser T, Kuhn M, Nicod L, Quadri F, et al: Diagnosis and management of chronic obstructive pulmonary disease: the Swiss guidelines. Official guidelines of the Swiss Respiratory Society. Respiration 2013;85:160-174.
4.
Rodriguez-Roisin R: Global Strategy for the Diagnosis, Management and Prevention of COPD. 2010.
5.
Husebø GR, Bakke PS, Aanerud M, Hardie JA, Ueland T, Grønseth R, Persson LJ, Aukrust P, Eagan TM: Predictors of exacerbations in chronic obstructive pulmonary disease - results from the Bergen COPD cohort study. PLoS One 2014;9:e109721.
6.
Self TH, Patterson SJ, Headley AS, Finch CK: Action plans to reduce hospitalizations for chronic obstructive pulmonary disease exacerbations: focus on oral corticosteroids. Curr Med Res Opin 2014;30:2607-2615.
7.
Connors AF Jr, Dawson NV, Thomas C, Harrell FE Jr, Desbiens N, Fulkerson WJ, Kussin P, Bellamy P, Goldman L, Knaus WA: Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med 1996;154(pt 1):959-967.
8.
Tokgoz Akyil F, Gunen H, Agca M, Gungor S, Yalcinsoy M, Sucu P, Akyil M, Sevim T: Patient outcome after chronic obstructive pulmonary disease exacerbations requiring non-invasive ventilation during hospitalization (in English, Spanish). Arch Bronconeumol 2016;52:470-476.
9.
Atsou K, Chouaid C, Hejblum G: Variability of the chronic obstructive pulmonary disease key epidemiological data in Europe: systematic review. BMC Med 2011;9:7.
10.
Köhnlein T, Windisch W, Köhler D, Drabik A, Geiseler J, Hartl S, Karg O, Laier-Groeneveld G, Nava S, Schönhofer B, et al: Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med 2014;2:698-705.
11.
Hartl S: The European COPD Audit: a pilot experience of 16 European countries. Pneumonol Alergol Pol 2012;80:501-504.
12.
López-Campos JL, Hartl S, Pozo-Rodríguez F, Roberts CM; European COPD Audit Team: European COPD Audit: design, organisation of work and methodology. Eur Respir J 2013;41:270-276.
13.
Roberts CM, López-Campos JL, Pozo-Rodríguez F, Hartl S; European COPD Audit Team: European hospital adherence to GOLD recommendations for chronic obstructive pulmonary disease (COPD) exacerbation admissions. Thorax 2013;68:1169-1171.
14.
British Thoracic Society Standards of Care Committee: Non-invasive ventilation in acute respiratory failure. Thorax 2002;57:192-211.
15.
Osthoff M, Leuppi JD: Management of chronic obstructive pulmonary disease patients after hospitalization for acute exacerbation. Respiration 2010;79:255-261.
16.
Wedzicha JA, Miravitlles M, Hurst JR, Calverley PM, Albert RK, Anzueto A, Criner GJ, Papi A, Rabe KF, Rigau D, et al: Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017;49:1600791.
17.
Schuetz P, Briel M, Christ-Crain M, Stolz D, Bouadma L, Wolff M, Luyt CE, Chastre J, Tubach F, Kristoffersen KB, et al: Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis 2012;55:651-662.
18.
Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Müller C, Huber P, Müller B, Tamm M: Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 2007;131:9-19.
19.
Ford PA, Durham AL, Russell RE, Gordon F, Adcock IM, Barnes PJ: Treatment effects of low-dose theophylline combined with an inhaled corticosteroid in COPD. Chest 2010;137:1338-1344.
20.
Zhang WH, Zhang Y, Cui YY, Rong WF, Cambier C, Devillier P, Bureau F, Advenier C, Gustin P: Can β2-adrenoceptor agonists, anticholinergic drugs, and theophylline contribute to the control of pulmonary inflammation and emphysema in COPD? Fundam Clin Pharmacol 2012;26:118-134.
21.
Yawn BP: Is “GOLD” standard for the management of COPD in clinical practice? Drugs Context 2012;2012:212243.
22.
Saleh A, López-Campos JL, Hartl S, Pozo-Rodríguez F, Roberts CM; European COPD Audit Team: The effect of incidental consolidation on management and outcomes in COPD exacerbations: data from the European COPD Audit. PLoS One 2015;10:e0134004.
23.
Schuurmans WM, Bussinger C, Müller V, Burkhalter AK, Bolliger CT: Smoking cessation training for physicians and other health professionals in Switzerland (in German). Ther Umsch 2010;67:409-414.
24.
Malatesha G, Singh NK, Bharija A, Rehani B, Goel A: Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 initial emergency department assessment. Emerg Med J 2007;24:569-571.
25.
Bloom BM, Grundlingh J, Bestwick JP, Harris T: The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med 2014;21:81-88.
26.
Woods JA, Wheeler JS, Finch CK, Pinner NA: Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014;9:421-430.
27.
Leuppi JD, Schuetz P, Bingisser R, Bodmer M, Briel M, Drescher T, Duerring U, Henzen C, Leibbrandt Y, Maier S, et al: Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013;309:2223-2231.
28.
Walters JA, Tan DJ, White CJ, Gibson PG, Wood-Baker R, Walters EH: Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014;9:CD001288.
29.
Walters JA, Tan DJ, White CJ, Wood-Baker R: Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014;12:CD006897.
30.
Stefan MS, Rothberg MB, Shieh MS, Pekow PS, Lindenauer PK: Association between antibiotic treatment and outcomes in patients hospitalized with acute exacerbation of COPD treated with systemic steroids. Chest 2013;143:82-90.
31.
Vollenweider DJ, Jarrett H, Steurer-Stey CA, Garcia-Aymerich J, Puhan MA: Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012;12:CD010257.
32.
Lindenauer PK, Stefan MS, Shieh MS, Pekow PS, Rothberg MB, Hill NS: Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med 2014;174:1982-1993.
33.
Olivieri C, Carenzo L, Vignazia GL, Campanini M, Pirisi M, Della Corte F, Navalesi P: Does noninvasive ventilation delivery in the ward provide early effective ventilation? Respir Care 2015;60:6-11.
34.
Ramsay M, Hart N: Current opinions on non-invasive ventilation as a treatment for chronic obstructive pulmonary disease. Curr Opin Pulm Med 2013;19:626-630.
35.
Boldrini R, Fasano L, Nava S: Noninvasive mechanical ventilation. Curr Opin Crit Care 2012;18:48-53.
36.
Rea H, Kenealy T, Adair J, Robinson E, Sheridan N: Spirometry for patients in hospital and one month after admission with an acute exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2011;6:527-532.
37.
Hartl S, López-Campos JL, Pozo-Rodríguez F, Castro-Acosta A, Studnicka M, Kaiser B, Roberts CM: Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit. Eur Respir J 2016;47:113-121.
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2017
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