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Respiratory point of care testing (R-POCT) to facilitate diagnosis and treatment in the community for COPD exacerbations

Introduction: COPD exacerbations are often managed with a default combination of antibiotics (Abx) and steroids (rescue pack), although a large proportion of infection is viral in origin. Patients are often admitted to hospital, adding to bed pressures, and antibiotic overuse risks development of resistance. We describe a novel service wherein patient are tested and (where appropriate) treated at home, without attending ED. Aims: To determine if R-POCT leads to reduction in inappropriate Abx prescribing, ED admission/ readmission; improved patient experience and quality of life (QOL); favourable impact on health economics. Methods: Patients access a helpline to contact the community respiratory team at the start of a presumed COPD exacerbation. Specialist nurses provide a hospital-at-home service, including taking nasal swabs for respiratory viruses and atypical bacteria, sputum samples, blood tests for CRP and procalcitonin. Samples are processed in a community hub and findings discussed with a physician: results and management plan for the patient are provided in one hour. QOL and HE questionnaires are collected regularly with close patient follow up. Results: We analysed the first 12 patients COPD GOLD C/D: average 3.5 exacerbations and 1 hospitalisations a year. The mean CRP was 15.3mg/L; PCT 0.16ng/ml and viral infection confirmed in 6 patients. Abx were avoided in 4 and hospital admission avoided in 2 patients. Discussion: R-POCT improves quality of care in severe COPD by delivering a safe, personalised approach -avoiding risks of inappropriate Abx and enhancing patient experience by testing at home, avoiding admission or even attendance in hospital.