Managing COPD exacerbations: A new clinical guideline

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The European Respiratory Society and the American Thoracic Society have released a guideline for the treatment of patients with COPD exacerbations.
The European Respiratory Society and the American Thoracic Society have released a guideline for the treatment of patients with COPD exacerbations.

The European Respiratory Society and the American Thoracic Society have released a clinical guideline for the treatment of patients with chronic obstructive pulmonary disease (COPD) exacerbations, published in the European Respiratory Journal.

The recommendations were created by a multidisciplinary task force of COPD experts using evidence syntheses and meta-analyses to address specific questions regarding the treatment of COPD exacerbations that are not answered by current guidelines.  

The evidence was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to develop recommendations regarding corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients with COPD exacerbations.

The task force made the following recommendations:

  • Ambulatory patients with an acute exacerbation of COPD should be treated with a short course (≤14 days) of oral corticosteroids (conditional recommendation, very low quality of evidence).
  • Antibiotics should be administered to ambulatory patients with an exacerbation of COPD (conditional recommendation, moderate quality of evidence).
  • Patients who are hospitalized with a COPD exacerbation should receive oral corticosteroids rather than intravenous corticosteroids if gastrointestinal access and function are intact (conditional recommendation, low quality of evidence).
  • Noninvasive mechanical ventilation should be used for patients who are hospitalized with a COPD exacerbation associated with acute or acute-on-chronic respiratory failure (strong recommendation, low quality of evidence).
  • A home-based management program (hospital-at-home) should be used for patients with a COPD exacerbation who present to the emergency department or hospital (conditional recommendation, moderate quality of evidence).
  • Patients who are hospitalized with a COPD exacerbation should undergo pulmonary rehabilitation within 3 weeks after hospital discharge (conditional recommendation, very low quality of evidence).
  • Clinicians should avoid initiating pulmonary rehabilitation during hospitalization for patients who are hospitalized with a COPD exacerbation (conditional recommendation, very low quality of evidence).

Reference

  1. Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: A European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017. doi:10.1183/13993003.00791-2016
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