| Abstract | CILJ ISTRAŽIVANJA: Cilj istraživanja bio je utvrditi u kojoj mjeri nalazi bolničkih hitnih službi i otpusna pisma bolesnika s akutnom egzacerbacijom KOPB-a hospitaliziranih u Klinici za plućne bolesti KBC-a Split sadrže potrebne podatke o akutnoj egzacerbaciji.
MATERIJALI I METODE: Ispitanici su odrasle osobe oba spola koje boluju od kronične opstruktivne bolesti pluća, a koji su zbog akutne egzacerbacije KOPB-a pregledani u bolničkoj hitnoj ambulanti Klinike za plućne bolesti KBC-a Split u periodu od studenog 2019. do veljače 2020. godine. Prikupljali su se demografski podatci (dob, spol), pušački status, podatci o stupnju težine KOPB-a, dosadašnjem liječenju, simptomima akutne egzacerbacije KOPB, dijagnostici i terapijskoj intervenciji kako u hitnoj ambulanti tako i tijekom hospitalizacije. Također, prikupili su se podatci o duljini trajanja i razlogu hospitalizacije, ponovnoj hospitalizaciji, postojećim komorbiditetima bolesnika, fenotipu akutne egzacerbacije te naputcima o prestanku pušenja i plućnoj rehabilitaciji.
REZULTATI: Istraživanjem je obuhvaćeno 30 bolesnika, medijan dobi bolesnika iznosio je 66,5 godina, a prosječno vrijeme trajanja hospitalizacije iznosilo je 11,26 dana. Vodeći razlog hospitalizacije bila je respiracijska insuficijencija. Nijednom bolesniku nije naveden podatak o stupnju težine KOPB-a prema GOLD smjernicama. Najučestaliji pridruženi komorbiditet bile su kardiovaskularne bolesti koje je imalo 70 % bolesnika. Najzastupljeniji simptom egzacerbacije bila je dispneja. Središnja vrijednost CRP-a iznosila je 12,2 mg/L. Vrijednosti CRP-a u bolesnika s infektivnim fenotipom i pneumonijom bile su značajno veće u odnosu na bolesnike s neinfektivnim fenotipom egzacerbacije KOPB-a. Najzastupljenija pretraga u vidu slikovne dijagnostike bio je RTG prsnog koša koji je učinjen 90% bolesnika. Terapija kisikom primjenjivana je u više od 90 % bolesnika, dok je neinvazivna mehanička ventilacija primjenjivana u 10 % bolesnika. Više od 70 % bolesnika liječeno je antibiotikom i intravenskim kortikosteroidima. Kratkodjelujućim beta2-agonistima liječeno je 70% bolesnika, a kratkodjelujućim antikolinergicima 50% bolesnika. U više od 90% bolesnika došlo je do eskalacije terapije za KOPB. Postupci glede prestanka pušenja bili su preporučeni 8 bolesnika od njih 14 aktivnih pušača (57%). Nijednom bolesniku nije bila preporučena plućna rehabilitacija. Unutar 12 mjeseci ponovo je hospitalizirano 20% bolesnika.
ZAKLJUČAK: Bolesnici nakon obrade i postupaka u hitnoj službi te nakon hospitalizacije ne dobivaju preciznu dijagnozu (stupanj težine i fenotip akutne egzacerbacije KOPB-a), odgovarajuću terapiju i naputke o kontroli. Također, bolesnicima se nakon hospitalizacije ne savjetuje plućna rehabilitacija, a postupci glede prestanka pušenja nedovoljno su preporučeni. |
| Abstract (english) | OBJECTIVES: The aim of the study was to determine in which extent hospital emergency services findings and discharged letters from patients with acute exacerbations of COPD hospitalized in the Clinic for Lung Diseases of Clinical Hospital Center Split contain the necessary data on acute exacerbations.
PATIENTS AND METHODS: Subjects are adults of both sexes suffering from chronic obstructive pulmonary disease, who were examined in the hospital emergency department of the Clinic for Lung Diseases of University Hospital of Split in the period from November 2019 to February 2020 due to acute exacerbation of COPD. Demographic data (age, sex), smoking status, data on the severity of COPD, current treatment, symptoms of acute exacerbation of COPD, diagnosis and therapeutic intervention in the emergency department and during hospitalization were collected. Also, data on the duration and reason for hospitalization, rehospitalization, existing comorbidities of patients, acute exacerbation phenotype, and guidelines on smoking cessation and pulmonary rehabilitation were collected.
RESULTS: The study included 30 patients, the median age of patients was 66,5 years, and the average duration of hospitalization was 11,26 days. The leading cause of hospitalization was respiratory failure. No patient was given information on the severity of COPD according to GOLD guidelines. The most common associated comorbidities were cardiovascular diseases, which were present in 70% of patients. The most common symptom of exacerbation was dyspnea. The median CRP was 12,2 mg / L. CRP values in patients with infectious phenotype and pneumonia were significantly higher compared with patients with non-infectious phenotype of COPD exacerbation. The most common imaging diagnosis was chest X-ray, which was performed in 90% of patients. Oxygen therapy was used in more than 90% of patients, while non-invasive mechanical ventilation was used in 10% of patients. More than 70% of patients were treated with antibiotics and intravenous corticosteroids. 70% of patients were treated with short-acting beta2-agonists and 50% with short-acting anticholinergics. COPD therapy escalated in more than 90% of patients. Smoking cessation procedures were recommended in 8 patients, of whom 14 were active smokers (57%). Pulmonary rehabilitation was not recommended for any patient. Within 12 months, 20% of patients were re-hospitalized.
CONCLUSION: After treatment and procedures in the emergency department and after hospitalization, patients do not receive a precise diagnosis (severity and phenotype of acute exacerbation of COPD), appropriate therapy and instructions on control. Also, patients are not advised to undergo pulmonary rehabilitation after hospitalization, and smoking cessation procedures are insufficiently recommended. |
