A recent study shows that COPD patients often receive substandard hospital care. Our recommendation: COPD patients should keep a list of recommended tests and treatments with them in case they are hospitalized.

Chronic obstructive pulmonary disease (COPD) – which includes chronic bronchitis and emphysema -- is the fourth leading cause of death in the United States. Now a study published in the Annals of Internal Medicine (Volume 144, page 894) reports that two thirds of patients hospitalized for acute flare-ups of COPD do not receive ideal care.

The study of 70,000 patients found that only a third of patients hospitalized for a COPD flare-up get all of the tests, treatments, and interventions recommended in the COPD treatment guidelines from the American College of Physicians and the American College of Chest Physicians.

In the vast majority of cases, a COPD patient received at least one recommended test or treatment while in the hospital: 97% received bronchodilators, 95% had a chest X-ray, 91% received supplemental oxygen; and systemic steroids and antibiotics were given in 85% of cases. But only two thirds of COPD patients got everything they were supposed to get, according to the guidelines. Women and older people with COPD were most likely to have ideal care.

Meanwhile, nearly half of the study subjects (45%) received at least one treatment that is not recommended, such as a methylxanthine bronchodilator, a sputum test, acute spirometry, chest physiotherapy, or mucolytic drugs.

Bottom-line advice: Someone who has COPD (especially a younger man) might make note of the recommended tests and treatments, just in case.