An algorithm for the management of chronic obstructive pulmonary disease patients in units of internal medicine

Patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are often hospitalized in internal medicine units (IMUs), and their management is challenging due to a multiplicity of factors affecting the outcome, such as correct patient classification, appropriate pharmacologic therapy, patient discharge, and follow-up. In this context, a standardized pathway (algorithm) for the management of these patients was designed and tested. Specifically, based on information collected through a survey on the management of COPD patients in IMUs, an initial version of an algorithm was designed by the scientific board and proposed to 45 IMUs for a 6-month period to evaluate its feasibility, usefulness, and critical issues. After this preliminary phase, a second version was released, which was again brought to the attention of the participating centers, leading to the final algorithm. The algorithm reports the steps for the management of patients with severe exacerbations of known or suspected COPD, namely: correct diagnosis, treatment of the acute phase, management of comorbidities, appropriate therapy at discharge, and planning of the follow-up. Focus is given to the shift from systemic therapy in the acute phase to early in-hospital inhalation triple therapy (inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β agonists) and the need for education in the use of the inhaler. The algorithm was considered useful by most of the participating centers. The proposed algorithm is an agile and usable tool for managing the main steps of care of COPD patients in IMUs. The future goal is to make the model available to a wider audience of internists.