P144 Standardising follow up of symptoms, tests, and outcome assessment after hospitalisation for exacerbation of COPD – A Delphi Survey

Introduction and ObjectivesHospitalised exacerbations of COPD lead to significant morbidity and mortality. Unlike most other common conditions treated in hospital (eg. pulmonary embolism and myocardial infarction), international guidelines do not define clinical characteristics, tests and outcomes to be assessed at time of follow up. We sought to evaluate the current Europe-wide expert view on demographic, clinical characteristics, comorbidities, investigations, and clinical outcomes to be assessed at follow up after a hospitalised exacerbation of COPD.MethodsA modified online Delphi survey of COPD experts was performed. 3 iterative rounds were undertaken. Importance and feasibility of items were assessed. Consensus and stability criteria were pre-defined.Results25 COPD experts from 18 European countries completed all 3 rounds of the Delphi survey. Of the 31 clinical signs assessed, 13 (42%) clinical signs achieved consensus as important to capture at time of follow up after hospitalised exacerbation of COPD. Similarly, only five clinical scores and questionnaires were thought to be important to capture at time of follow up after hospitalisation. These were the modified Medical Research Council (mMRC) dyspnoea index, COPD Assessment Test (CAT), the BODE index (BMI, Obstruction, Dyspnoea and Exercise Capacity), the Global initiative for chronic obstructive lung disease (GOLD) I-IV and A-D classifications. Experts agreed by consensus that they would consider most of the scores at time of follow up but would not suggest including them routinely.Abstract P144 Table 1Tests at time of follow up after hospitalisation for exacerbation of COPDMust include Consider inclusion Exclude Arterial Blood GasFull blood countSpirometryInspiratory capacityDiffusion capacity of lung for carbon monoxidePlethysmography Urea, electrolytes, and creatinineBrain Natriuretic PeptideSputum microscopy & cultureGlucoseC-reactive proteinElectrocardiogramChest X-RaySit to standPatient symptom diaries Liver function testsPhosphate, calcium, magnesiumLactate DehydrogenaseFibrinogenD-DimerImmunoglobulinsProcalcitoninUrine dipstickUrine microscopy and cultureViral throat swabsGlycated HaemoglobinExhaled Nitric OxideFrequency oscillometry testing ConclusionHospitalised exacerbations of COPD are managed and followed up differently throughout Europe. Standardisation will help guide research to improve outcomes