COPD Rescue Pack Use: Improving Safety, Reducing Overuse and Enhancing Review

Aneurin Bevan University Health Board

Project summary

Chronic obstructive pulmonary disease (COPD) rescue packs (oral corticosteroids with or without antibiotics) are recommended for selected patients at risk of exacerbations, alongside education on appropriate use. However, concerns exist that repeated use without clinical review can lead to excess steroid exposure, antimicrobial resistance, and missed opportunities to optimise long‑term management.

A retrospective primary care audit was undertaken across dispensing GP practices within Aneurin Bevan University Health Board to evaluate rescue pack prescribing and associated follow‑up care. The audit reviewed 60 patients issued at least one rescue pack over a 12‑month period. Data collected included number of rescue packs issued, evidence of post‑exacerbation and annual COPD reviews, smoking status, adherence to maintenance therapy, inhaler disposal practices, and awareness of digital self‑management tools such as the COPD Hub app.

Findings demonstrated that frequent rescue pack prescribing without structured review was common, with some patients receiving multiple packs annually without documented follow‑up. A clear high‑risk phenotype emerged, including current smokers and patients with repeated exacerbations.

The project identified a systemic gap between prescribing and recommended care processes, where rescue packs were being used as a reactive management strategy rather than as a trigger for review.

Key recommendations included introducing mandatory clinical review after two or more rescue packs in 12 months, avoiding routine repeat prescribing, embedding inhaler disposal advice, and improving use of digital self‑management tools.

This project highlights a scalable opportunity to improve patient safety, optimise prescribing, and reduce avoidable exacerbations and hospital admissions.