Best-Practice Evidence Based Medicine for the Effective Management of Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition characterised by progressive airflow limitation through the lungs. It is a significant socioeconomic burden and appropriate management of COPD has become a health priority, resulting in a breadth of innovation and published research. There are international guidelines that collate this evidence in order to steer clinical decision making. Guideline concordant care results in a reduced rate of COPD exacerbations, improving hospital utilisation and patient related outcomes. Despite this, uptake and adherence to guidelines remains variable in practice and interventions that address this are desirable. The research undertaken in this thesis aims to synthesise and consolidate evidence to inform best-practice management of COPD across key treatment areas. It further aims to identify barriers and facilitators to provision of best-practice care for people with COPD. Synthesis and consolidation of key areas of the evidence base relating to COPD management occurred through two Cochrane reviews (Chapters 3 and 4), two systematic reviews (Chapters 5 and 6) and one literature review (Chapter 7). Though in general the evidence base underpinning these key areas of practice was found to be limited and somewhat out-dated some recommendations can be made from the findings. Inactivated vaccine reduces the number of COPD exacerbations and should be considered as part of everyday best-practice. The use of oxygen therapy for the pre-hospital management of acute exacerbations of COPD (AECOPD) is potentially dangerous when delivered at high flow, with a titrated approach associated with significantly reduced mortality. Routine use of short acting bronchodilators in the hospital setting to treat AECOPD should be initiated at a low dose (2.5mg) of salbutamol delivered via metered-dose inhaler to avoid increased risk of adverse events. Smoking cessation is essential to COPD management and available evidence suggests that interventions should be tailored to the individual and the setting within the hospital space. Finally, clinicians should seriously consider their decision-making around prescription of pharmacotherapy for exacerbations of COPD, particularly the potentially superfluous addition of muscarinic agents. Through qualitative investigation (Chapter 8), several organisational and behavioural barriers to the provision of best-practice care for COPD by health professionals were identified. In addition, potential facilitators were highlighted that may be used to inform future innovation strategy to improve translation of evidence into practice, including the use of smartphone technology. The evidence produced in this thesis suggests a need for updated research specifically supporting the in-hospital management of people with an exacerbation of COPD. Furthermore, the findings presented in this thesis have provided an evidence base that has acted as the foundation for the next phase of research essential to improve provision of clinical care for people with COPD. The work has underpinned the development of a theory-based multi-component intervention (Appendices 2 and 3) and some of the clinical practice recommendations within it. Moreover, next steps are planned to assess the feasibility and evaluation of this intervention, with the view to conducting a full-scale evaluation in the future with a view to better support translation of evidence into practice.

Author dc:creator

• Kopsaftis, Zoe Antonia

Advisors dc:contributor.advisor

• Nottle, Mark
• Carson-Chahhoud, Kristin
• Phillips, Paddy

• Evidence-based practice
• chronic obstructive pulmonary disease
• COPD

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/2440/120663

OAI identifier oai:identifier

oai:digital.library.adelaide.edu.au:2440/120663