Real-world treatment patterns and outcomes in severe acute exacerbations of chronic obstructive pulmonary disease: an observational study

Background Chronic obstructive pulmonary disease (COPD) represents a significant healthcare burden. Acute exacerbation (AECOPD) episodes frequently require hospitalization, and a number of these involve intensive care (ICU) unit admission. Noninvasive ventilation (NIV) use is associated with superior outcome, despite this, real-world data indicate that NIV remains underutilized. Our aim was to characterize NIV utilization for severe AECOPD patients admitted to participating Hungarian ICUs. Methods We conducted a 2-month long prospective observational study of AECOPD patients in ICUs and collected national health registry data for parallel validation. Results In five participating ICUs 27 (4.86%) out of 555 screened patients were recruited. Patients were predominantly older, overweight, and had several comorbidities. Hypercapnia, elevated bicarbonate levels and pneumonia were common at admission. ICU mortality was 22.2%, and in-hospital mortality rate reached 37%, compared to a predicted 55 (25–73%) ICU mortality. NIV was used in most patients, however, only 25.9% received NIV exclusively. NIV was the initial ventilation type in 55.6% of cases, but early NIV failure rate was 46.7%. Difficult weaning was reported in 30% of patients. NIV failure was associated with longer ICU stay and increased hospital mortality. National Health Fund data confirmed overall low NIV use, with only 4.8% of COPD patients receiving this therapy. Conclusions Severe AECOPD in Hungarian ICUs is currently associated with low NIV utilization, high NIV failure rate and considerable hospital mortality. Future studies should focus on appropriate patient selection, initial NIV application and therapy optimization.