Optimizing In-Hospital Chronic Obstructive Pulmonary Disease (COPD) Care in Canada: Challenges, Evidence, and Future Directions

Résumé

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) represent the leading cause of hospital admissions in Canada, second only to childbirth, with recent data showing an upward trend in hospitalizations since 2010.^1,2 A substantial proportion of patients are also readmitted for AECOPD within the first
3 months after discharge.^3,4 National spending for hospital-based care for AECOPD is estimated to exceed 4 billion Canadian dollars annually.⁵ AECOPD therefore represent a significant burden on the Canadian healthcare system. These events, which may be referred to in lay terms as “lung attacks”, are associated with considerable patient morbidity, including a higher risk of recurrent AECOPD, accelerated lung function decline, poorer quality of life, and increased mortality.^6-9 Indeed, previous reviews have reported all-cause mortality rates of up to 20–25% one year after a severe AECOPD and approximately 50% at 5 years.^10,11 This paper aims to identify key barriers to optimal chronic obstructive pulmonary disease (COPD) management within the Canadian healthcare system for hospitalized patients and for those treated in the emergency department (ED).