• COPD Exacerbations

Even in an adequately resourced system, admission to hospital with an acute exacerbation of COPD (AECOPD) could be a frightening and unpleasant experience for patients with the condition and for their relatives. Unfortunately, the UK Government has made a political choice to underfund the National Health Service (NHS) by more than £20 billion per year by 2020 and there has already been a 26% cut in the number of people over 65 receiving local authority social care since 2010.1 The latest report from the UK's 2014 National COPD audit programme—COPD: who cares when it matters most? 2 warns of patients ‘on a continuous cycle of admission’ with an ‘overriding impression provided by the data of a system that is not only stressed, but is ultimately failing COPD patients’. The report found that 8% of patients discharged following an AECOPD died within 90 days of admission, 25% were readmitted within 30 days and 43% within 90 days. Fewer than half (43%) of the readmissions were due to COPD. The number of prior admissions to hospital was associated with postdischarge mortality and subsequent readmission risk. Readmission was much more likely in those with a longer length of stay and in patients who had been discharged to sheltered accommodation.

In Thorax, Echevarria and colleagues describe the development of a new prognostic tool for use in patients admitted with an AECOPD.3 The initial derivation and subsequent validation cohorts, including six UK centres, were those that were also used in the development of the Dyspnoea, Eosinopenia, Consolidation, Acidaemia, and atrial Fibrillation (DECAF) score, a tool to identify patients who can be safely discharged.4 ,5 Patient characteristics, selected on the basis of literature review and clinical plausibility, and which were consistently recorded across sites, were related to the risk of readmission or death …