Respiratory Clinicians' Views on Offering "Rescue Packs" to Patients Discharged After COPD Exacerbation: Qualitative Interview Study.

"Rescue packs" for COPD exacerbations, consisting of a course of antibiotics and steroids, have become part of self-management strategies for many patients living with COPD. Currently, in the UK, rescue packs are guideline-recommended but not routinely offered on hospital discharge. They are, however, commonly prescribed by primary care teams. This study examined hospital-based respiratory clinicians' views on offering patients rescue packs following hospitalisation for COPD exacerbations. We conducted 24 individual and joint semi-structured interviews telephone or videocall with 30 clinicians (respiratory consultants, respiratory registrars and specialist nurses) in 20 UK hospitals to understand variation in practice around, and views on, offering rescue packs to discharged COPD patients. Interview data were analysed using the constant comparative method. Clinicians' views on offering rescue packs were a mixture of concerns and recognition of potential benefits. Concerns included antimicrobial resistance, individual overuse of antibiotics, and potential side effects of steroids, especially in patients with poorer understanding of their own condition, with lower self-management skills, or who found it difficult to access primary care. Recognised benefits included the potential to prevent future exacerbations, empowering patients by supporting COPD self-management, and circumventing the difficulties of securing an urgent primary care appointment. There was a consensus that supporting patients in self-management of COPD was key to effective care. Given the increasing role of self-management for patients living with COPD, it is vital to ensure that patients are able to appropriately use rescue packs.