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New guidelines for treatment and management of COPD exacerbations

March 15, 2017

A multi-disciplinary task force of chronic obstructive pulmonary disease (COPD) experts has published comprehensive new guidelines on the treatment of COPD exacerbations, providing new advice on the treatment of exacerbations in outpatients and the initiation of pulmonary rehabilitation during or after an exacerbation of COPD, among other topics.

The European Respiratory Society (ERS) and American Thoracic Society (ATS) collaborated to develop the new guidelines, published today (16 March 2017) in the European Respiratory Journal. Chronic obstructive pulmonary disease (COPD) is a long-term condition that causes inflammation in the lungs, damaged lung tissue and a narrowing of the airways, making breathing difficult. The World Health Organization (WHO) predicts that COPD will become the third leading cause of death worldwide by 2030.

Previous guidelines have relied on evidence gathered mostly from patients hospitalised with severe exacerbations but the new document covers antibiotic and corticosteroid therapy for outpatients who experience mild and moderate exacerbations. The recommendations for outpatient care also include starting pulmonary rehabilitation 3 weeks after discharge from hospital following a severe exacerbation.

In addition, the paper provides recommendations related to non-invasive ventilation treatment and home-based management, and is centred on six key questions:
  • Oral corticosteroids versus. no corticosteroids for non-hospitalised patients
  • Oral corticosteroids vs. intravenous corticosteroids for hospitalised patients
  • Antibiotics vs. no antibiotics for ambulatory patients
  • Non-invasive mechanical ventilation vs. usual care for hospitalised patients
  • Home-based management vs. hospitalisation
  • Pulmonary rehabilitation vs. usual care for hospitalised patients
Professor Jadwiga Wedzicha, lead author of the guideline and editor-in-chief of the American Journal of Respiratory and Critical Care Medicine, commented: "Our guideline provides new recommendations based on more solid evidence for established therapies and including populations of patients that were not significantly represented in previous guidelines. The recommendations cover the different kinds of drugs and therapies that can be used at home and in a hospital setting, answering new questions for healthcare professionals."

Dr Marc Miravitlles, the ERS Guidelines Director and co-author of the new guideline, commented: "This new guideline can help improve the management of exacerbations in patients with COPD. The recommendations include new advice for general practitioners as they refer to ambulatory patients who may experience mild or moderate exacerbations. In addition, we provide new evidence to effective strategies, such as pulmonary rehabilitation, which has been shown to improve the outcomes of exacerbated COPD patients."

The evidence used to shape each debate was subject to comprehensive analysis using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Each question is broken down in to sub-sections to detail a summary of the evidence, benefits, harms, further considerations, conclusions and research needs, wider expert opinions, ERS/ATS recommendation, remarks, and values and preferences.

The authors of the task force state that more detailed studies should be carried out in several of the areas discussed in the paper, to enable a more comprehensive set of guidelines be produced. They also state that recommendations should be reconsidered when new evidence becomes available.
Title: Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society (ERS/ATS) guideline

European Lung Foundation

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