Discharge Plan for COPD Exacerbation

Pre-Discharge Clinical Assessment

The European Respiratory Society recommends recording FEV1 measurement to establish baseline post-exacerbation lung function 2
The British Thoracic Society suggests checking arterial blood gases on room air in patients who presented with hypercapnic respiratory failure or low PaO2 on admission, as this guides assessment for long-term oxygen therapy (LTOT) 2, 3
The American Thoracic Society recommends transitioning from nebulized bronchodilators to usual inhaler at least 24-48 hours before discharge to confirm patient can manage their device independently 2, 3
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends ensuring clinical stability with less dyspnea, improved peak flow, and improved oxygen saturation before discharge 2

The American College of Chest Physicians recommends stopping oral corticosteroids abruptly after 7 days unless there are specific reasons for long-term use; do not continue beyond the acute treatment period 1, 2, 3
The European Respiratory Society suggests that antibiotics typically do not need continuation beyond 7 days after discharge 4, 3

The British Thoracic Society recommends assessing for LTOT if PaO2 ≤7.3 kPa (55 mmHg) or SaO2 ≤88% on room air despite optimal therapy, confirmed twice over 3 weeks 3
The American Thoracic Society suggests that LTOT should be prescribed for at least 15 hours/day to improve survival in patients with chronic respiratory failure 3

The European Respiratory Society recommends verifying patient (or carer) understands the treatment prescribed and can demonstrate proper use of all delivery devices before discharge 4, 1
The American College of Chest Physicians suggests providing written action plan that includes instructions on recognizing early signs of exacerbation and when to initiate treatment or seek medical attention 1

The American College of Chest Physicians recommends counseling all current smokers on smoking cessation and offering pharmacotherapy (nicotine replacement, varenicline, or bupropion) plus behavioral support 4, 1

The American Thoracic Society recommends referring all patients to pulmonary rehabilitation program to begin within 4 weeks of discharge, as this improves exercise capacity and quality of life with benefits evident at 6 months 5
The European Respiratory Society suggests that pulmonary rehabilitation initiated after exacerbation has demonstrated significant improvements in functional outcomes 5

The American College of Chest Physicians recommends scheduling follow-up within 30 days of discharge (ideally within 2 weeks) to reduce exacerbation-related readmissions 6
The British Thoracic Society suggests informing the patient's GP within 48 hours of discharge with complete discharge summary including medications, follow-up plans, and any pending investigations 4, 1

The American Thoracic Society recommends ensuring adequate home support to enable patient to cope at home, including assessment of living situation and suitability of accommodation 4, 1
The European Respiratory Society suggests arranging home care services if needed, including district nursing, home oxygen delivery, or social services support 5

The American College of Chest Physicians recommends providing sufficient medication to last until the next opportunity for consultation with the GP or specialist, typically a 30-day supply 4, 1
The European Respiratory Society suggests including written prescriptions for all maintenance medications with clear dosing instructions 1

The British Thoracic Society recommends not discharging patients on nebulized therapy without confirming they can manage with standard inhalers, as this indicates inadequate recovery 2, 3
The American College of Chest Physicians suggests not continuing oral corticosteroids indefinitely without specific indication, as this increases adverse effects without proven benefit 1, 2
The American Thoracic Society recommends not discharging without confirming adequate social support, as this is a major risk factor for readmission 4, 1
The European Respiratory Society suggests not delaying pulmonary rehabilitation referral, as early initiation (within 4 weeks) provides maximum benefit 5