References
Acute exacerbation of COPD: Are we still over-oxygenating?
Abstract
Chronic obstructive pulmonary disease (COPD) affects thousands of people across the UK. It accounts for a large amount of hospital admissions, which are often seen by the ambulance service during acute exacerbations. Discussion has surrounded the amount of oxygen this type of patient should be receiving during acute exacerbations. Research to provide evidence–based practice for the use of oxygen in the hospital and pre-hospital environment has been ongoing for several years. In 2009 the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) changed their guidance following the British Thoracic Society's (BTS) release of new guidelines in oxygen use in adult patients, thus determining that oxygen should be delivered in a more precise manner. However in light of current evidence could further changes be made in the delivery of oxygen, by using air–driven nebulisation during the delivery of drugs to patients presenting in the pre-hospital environment with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This would allow patients to receive an appropriate amount of oxygen during their transfer to hospital, giving improved care and treatment of patients at risk of hypercapnic respiratory failure. This article will discuss the changes to practice which have already been identified and recommended and also discuss the potential implications these changes may have on patient care.
The Department of Health (DH) approximates that 835 000 people have been diagnosed with chronic obstructive pulmonary disease (COPD) in England to date (DH, 2010), but it also estimates that over 3 000 000 people living in the UK are currently suffering with the disease. Emergency calls to patients suffering with acute exacerbation of COPD (AECOPD) account for a large portion of 999 call outs and it remains the second most common cause of emergency admission to hospital and the fifth largest cause of re-admission to hospital in England (DH, 2010).
In 2008 the British Thoracic Society (BTS) released new guidelines regarding oxygen use in the adult patient; providing evidenced–based guidance on how oxygen should be delivered to all adult patients, advocating the importance of appropriate oxygen therapy that included the potential risks of giving too much oxygen to the patient (BTS, 2008). Traditionally, there has been an instilled belief among ambulance staff that oxygen can do no harm (New, 2006), and therefore the flow rate of oxygen in the past has been tailored by each individual paramedic at thier discretion. This belief is currently being dispelled, as clinicians are developing the skills to review journal articles and understand the evidence and reasoning behind the changes in practice. It has been acknowledged in a recent audit that the use of oxygen to prevent hypoxia has improved and is being managed well with the use of pulse oximetry (Matthews, 2010/xref>). During 2009, the Joint Royal Colleges Ambulance Liaison Committee ( JRCALC) incorporated the suggested changes by the BTS into to their pre-hospital guidelines of oxygen administration, therefore reinforcing the need for change. Despite these changes in practice, could further steps (such as air driven nebulisation) be incorporated into pre-hospital treatment to provide a more appropriate care package for a patient presenting with an AECOPD that may be at risk of hypercapnic respiratory failure (type 2) due to over oxygenation.
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