Emergency department management of exacerbation of chronic obstructive pulmonary disease: low compliance or real world?

摘要

We read with interest the retrospective audit by Consi-dine and colleagues.1 They conclude, There was variation in the use of high level evidence for the ED management of exacerbation of COPD. The highest rate of compliance was non-use of methylxanthines and the greatest deficit was poor compliance with evidence related to NIPPVWe confirm that the narrow therapeutic index of methylxanthines is largely responsible for the low prescription in emergency department (ED) of this drug in patients whose medical history is rarely known by emergency physicians. Even if when used effectively and safely, it can have significant clinical benefits for patients. Moreover, theophiline could even reverse the glucocor-ticoid resistance in inflammatory respiratory diseases.