A Consensus-Driven Algorithm for AECOPD Management in Croatian Emergency Departments: Preliminary Initiative

Background/Objectives: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a frequent cause of emergency room (ER) visits, yet assessment, treatment, and discharge processes may lack standardization. This initiative aimed to identify perceived practice gaps and develop a consensus-based algorithm for AECOPD management in Croatian ERs. Methods: In 2025, 20 ER physicians from University Hospital Centres Zagreb and Split completed a structured questionnaire, addressing challenges in AECOPD recognition, assessment, treatment, and discharge. Findings were considered alongside Croatian and international COPD guidelines during three iterative, structured multidisciplinary workgroup meetings. The algorithm was tailored to local clinical practice and healthcare organization, with a predefined consensus threshold of more than 80% agreement. Results: The main perceived gaps concerned pharmacological treatment optimization and escalation (90%), discharge planning and follow-up (85%), and decisions regarding non-invasive ventilation, treatment escalation, and hospital admission (80%). These findings served as a basis for developing the clinical algorithm covering early recognition, differential diagnosis, severity assessment, severity-based management, maintenance treatment optimization, and discharge and follow-up recommendations. The algorithm was disseminated through printed posters in 35 major Croatian hospitals, professional society websites, and presentations at national congresses. Conclusions: This initiative translated identified practice gaps, evidence-based recommendations, and multidisciplinary expert input into a pragmatic algorithm for AECOPD management in Croatian ERs. It provides a proposed framework to support standardized assessment, treatment, discharge planning, and referral. Given the small, non-random sample, the findings should be interpreted cautiously. Further evaluation is needed to assess implementation, uptake, and potential effects on clinical practice and patient outcomes.