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Table 1 Clinical activities for management of patients hospitalized with COPD exacerbation

From: Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation

1. Medical history before exacerbation: prior measures of lung function (B)* 37. Smoking cessation advice when active smoker (A)
2. Medical history before exacerbation: spirometric classification of severity (B) 38. Appropriate prescription of short-acting bronchodilatators (A)
3. Medical history before exacerbation: documenting frequency andseverity of attacks of breathlessness (B) 39. Appropriate prescription of long-acting bronchodilatators(β-agonists and/or anticholinergics) (A)
4. Medical history before exacerbation: documenting frequency andseverity of chronic cough (B) 40. Appropriate prescription of inhaled corticosteroids (A)
5. Medical history before exacerbation: history of chronicsputum production (B) 41. Appropriate prescription of glucocorticosteroids: oralor intravenous (A)
6. Medical history before exacerbation: documenting possible limitationof daily activities (B) 42. Appropriate prescription of methylxanthines (theophyllineor aminophylline) (A)
7. Medical history before exacerbation: prior arterial blood gasmeasurements in sTable condition (B) 43. Antibiotics in patients if indicated (A)
44. Patient education information about recognition andtreatment of exacerbation (A)
8. Medical history before exacerbation: number of previousexacerbations in the previous year (B) 45. Patient education: instruction on how to use inhalers (A)
9. Medical history before exacerbation: number of previoushospitalizations (B) 46. Chest physiotherapy: sputum clearance (A)
47. Referral to pulmonary rehabilitation (A)
10. Medical history before exacerbation: pre-existing co-morbidities (A) 48. Monitoring of fluid balance (A)
49. Fluid administration in dehydrated patients (A)
11. Medical history before exacerbation: present treatment regimen (A) 50. Supplementary nutrition in patients with BMI <20 (B)
51. Screening and update of vaccination status (B)
12. Medical history before exacerbation: smoking status (B) 52. Deep venous thrombosis prophylaxis (A)
13. Medical history before exacerbation: sleeping and eating difficulties (B) 53. Treatment of co-morbid conditions (A)
14. Assessment of symptoms: physical examination (B) 54. Initiation of long-term oxygen therapy (LTOT) if thepatient remains hypoxemic (A)
15. Assessment of differential diagnosis (B) 55. Assessment of medical discharge criteria (D)
16. Assessment of co-morbidities (B) 56. Assessment and management of home situation (A)
17. Temperature (B) 57. Oral information and discharge letter regarding prescribedhome therapy and follow-up appointment (B)
18. Pulse rate (B) 58. Arrangement of follow-up appointment four to six weeksafter discharge (D)
19. Blood pressure (B) 59. Medical history before exacerbation: number of previousadmissions to ICU (D)
20. Alertness (B) 60. Medical history before exacerbation: cardiovascular status (B)
21. Skin color (B) 61. Glucose monitoring (B)
22. Pulse oximetry (D) 62. CT THORAX: 1 X year (B)
23. Arterial blood gas measurement: At admission (B) 63. ECHO CARDIO: 1 X year (B)
24. Arterial blood gas measurement: prior to discharge inpatients hypoxemic during a COPD exacerbation (B) 64. Patient education: information about the nature of COPD (A)
25. Arterial blood gas measurement: in the following threemonths in patients hypoxemic during a COPD exacerbation (D) 65. Patient education: self-management plan (A)
26. Arterial blood gas measurement: after discharge in patientswith long term oxygen therapy (LTOT) (B) 66. Patient education strategies for minimizing dyspnoea (A)
27. Chest X-ray (B) 67. Patient education information about oxygen treatment (A)
28. ECG (B) 68. Physiotherapy: breathing techniques (A)
29. Blood examination: hematology (B) 69. Physiotherapy: Activities of Daily Life (A)
30. Blood examination: biochemical tests (B) 70. Physiotherapy: positioning (A)
31. Blood examination: theophylline level in patients on theophyllinetherapy at admission (B) 71. Identification for pulmonary rehabilitation determinant (B)
32. Sputum culture and anti-biogram (B) 72. Body mass index (BMI) determinant (A)
33. Spirometry during hospitalization (not earlier than Day 3 becauseof acute condition) (C) 73. Screening for weight loss (A)
34. Admission to ICU if exacerbation is life threatening (B) 74. Referral to dietician in patient with obesity or cachexie (B)
75. Assessment and management of anxiety and depression (B)
35. Controlled oxygen therapy in hypoxemic patients (A) 76. Information letter for general practitioner (B)
36. Assisted ventilation if necessary (A) 77. Discharge checklist (B)