Treatment of exacerbations of Chronic Obstructive Pulmonary Disease - a co-operation between primary health care and hospital care: a prospective, randomised trial

INTERVENTION: Control arm: patients with exacerbation COPD receive 'care as usual'. Intervention arm: patients with exacerbations are treated by their General Practitioner (GP) following the study protocol. This means a short course of oral steroids (30 mg daily, seven to ten days, in accordance with the Dutch College of General Practitioners [NHG] guideline for COPD). Antibiotics should be prescribed following the NHG guideline for COPD. There is an extra opportunity to refer to a pulmonologist for a one‐time consultation. CONDITION: Chronic Obstructive Pulmonary Disease (COPD) ; Respiratory ; Pulmonary diseases PRIMARY OUTCOME: Improvement in patients' health (faster recovery). SECONDARY OUTCOME: The health care process (use of antibiotics and health care services). INCLUSION CRITERIA: 1. Patient meets the clinical criteria of Chronic Obstructive Pulmonary Disease (COPD): a. Chronic bronchitis: chronic cough and sputum production on most days during at least three months of the year, during at least two consecutive years and/or b. COPD defined as an expiratory flow obstruction determined by spirometry, where the disorder does not vary seriously during several months of observation 2. Diagnosis of COPD in medical dossier 3. Indications for exacerbation a. Increased dyspnoe, +/‐ accompanied by increased volume and/or purulence of sputum and/or cough b. Increased dyspnoe developed in a short period (less than four weeks) c. Adaptation in medication is necessary