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Exacerbations of COPD place enormous stress on acute healthcare systems—they are one of the most common causes of emergency hospital admission and frequently result in readmission. Acute healthcare provision in England and Wales has adapted to deliver ‘front-door’ efficiency, with the rise of acute physicians and an emphasis on seeing hospitalised patients quickly to improve safety and facilitate early discharge—an example of the popular healthcare improvement mantra that ‘every system is perfectly designed to get the results it gets’. From this perspective, the results of the most recent national secondary care COPD audit are highly satisfying, demonstrating reduced inpatient mortality and length of stay.1 However, there is substantial national variation in acute care1 and readmission rates remain worryingly high, with more than 60% of patients readmitted to hospital at least once in the year following discharge.2
Outcomes from acute exacerbations of COPD are dependent on several factors beyond quality of care. These include the severity of the acute event, whether physiological derangements respond and improve to treatment during the admission,3 the baseline severity of respiratory disease in the individual, the influence of comorbidities and extra-pulmonary manifestations such as sarcopenia and frailty,4–7 and the individual's self-management skills and resilience.8
This is illustrated in the work of …
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