Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multicentre observational cohort study

Wildman, et al. report on the potential pessimism of doctors admiting
COPD and asthma patients to intensive care. Since the 18 month study
period in 2002/2003, there has been continued evolution in the
availability and provision of non-invasive ventilation, in particular Bi-
level Positive Airway Pressure(BIPAP), outside of intensive care. The vast
majority of acute Trusts now have BIPAP devices readily availible for use
in Accident and Emergency, Respiratory wards or Medical High Dependency
Units, which were not significantly represented in this study.
Accordingly, the vast majority of current COPD patients are not admitted
to Intensive Care for respiratory support. This study does not report the
proportion of patients who may have received non-invasive ventilation
which, in its early development, did neccesitate admission to intensive
care in many hospitals. Difficulty weaning severe COPD patients off a
ventilator is often the main reason for pessimism and refusal of intensive
care admission. I presume that nearly all patients with asthma would be
expected to survive their admission to intensive care and should not
therefore been included in this cohort.

Competing interests:
None declared