COPD is a heterogeneous disease associated with repeated exacerbations and high healthcare use. Systematic assessment clinics allow comprehensive multidisciplinary review and institution of personalised treatment plans with proven benefits in severe asthma. We examined the impact of this model of care on COPD hospitalisations.

At the COPD At-Risk Assessment (CARA) clinic, patients with high symptom burden and high healthcare use undergo medical, nursing, and physiotherapy assessment. Individualised optimisation strategies are implemented. For this study, the rate of COPD hospitalisations at 6- and 12-months post-CARA were compared to the 12 months pre-CARA.

Of 53 patients, 60% were female with a mean(SD) age of 69 (8)years. Mean(SD) FEV1% was 50 (22)%.  One-quarter required long-term oxygen therapy, 40% ambulatory oxygen and 25% were prescribed home NIV.  Mean(SD) hospitalisation rate 12 months pre-CARA was 1.65 (1.56). At CARA, NIV and/or oxygen therapy prescription was changed in 26% of patients.  Inhaled therapy was amended in 47%; this included device change in 40% and inhaled corticosteroid dose reduction in 9%. Azithromycin was added to therapy in 4%. At 6-month follow up, 4 patients had died and COPD hospitalisation rate had fallen to 0.50 (0.75), p<0.01. The total number of COPD hospitalisations at 6 months reduced by 69%. At 12-month follow-up, a further 3 patients had died and the COPD hospitalisation rate was 0.80 (0.96), p=0.04, n=30. At 12 months the total number of COPD hospitalisations had reduced by 42%.

A systematic assessment approach to outpatient COPD care facilitates individualised COPD optimisation and has substantially reduced hospitalisations in this cohort of severe COPD patients.