Clinical pathway for acute exacerbations of chronic obstructive pulmonary disease: method development and five years of experience

Int J Chron Obstruct Pulmon Dis. 2011;6:365-72. doi: 10.2147/COPD.S20423. Epub 2011 Jun 29.


Background: Randomized controlled trials, evidence-based medicine, clinical guidelines, and total quality management are some of the approaches used to render science-based health care services. The clinical pathway for hospitalized patients suffering from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is poorly established, although a clinical pathway is an integral part of total quality management.

Aim: To evaluate the outcomes of patients hospitalized with AECOPD in Japan, treated with a clinical pathway following published guidelines.

Methods: Prospective data were collected for patients with AECOPD admitted to a general hospital over a 5-year period since 2003. The clinical pathway was designed to establish general rules for the entire treatment protocol. The clinical pathway indicates which treatments and interventions should be performed, and when. In this study, health care providers were required to check the clinical pathway sheets to determine the next step of treatment.

Results: This study analyzed 276 hospitalizations in 165 patients. The clinical pathway was interrupted and defined as a dropout in 45 cases (16.3%). Nine patients died during hospitalization (3.3%). Oxygen was administered in 232 hospitalizations (84.1%). Noninvasive positive pressure ventilation (NPPV) treatment was administered in 110 hospitalizations (39.9%). The rate of intubation in those cases where NPPV treatment had been administered was 8.2% (9 cases out of 110). The average length of stay (LOS) was 20.3 days, and the median value was 15 days. The LOS was longer than 30 days in 34 admissions (12.3%), mainly due to complications.

Conclusion: AECOPD can be managed using a clinical pathway. This clinical pathway could fill the gap between guidelines and clinical practice.

Keywords: AECOPD; COPD; mortality; pulmonary rehabilitation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Bronchodilator Agents / therapeutic use
  • Critical Pathways* / standards
  • Decision Support Techniques
  • Female
  • Hospital Mortality
  • Hospitals, General
  • Humans
  • Inpatients
  • Intubation, Intratracheal
  • Japan
  • Length of Stay
  • Lung / physiopathology*
  • Male
  • Outcome and Process Assessment, Health Care*
  • Oxygen Inhalation Therapy
  • Patient Dropouts
  • Positive-Pressure Respiration
  • Practice Guidelines as Topic
  • Program Development
  • Program Evaluation
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Respiratory Function Tests
  • Time Factors
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Bronchodilator Agents