Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: American College of Chest Physicians and Canadian Thoracic Society Guideline.
Chest. 2014 Oct 16;
Authors: Criner GJ, Bourbeau J, Diekemper RL, Ouellette DR, Goodridge D, Hernandez P, Curren K, Balter MS, Bhutani M, Camp PG, Celli BR, Dechman G, Dransfield MT, Fiel SB, Foreman MG, Hanania NA, Ireland BK, Marchetti N, Marciniuk DD, Mularski RA, Ornelas J, Road JD, Stickland MK
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the United States as well as the rest of the world. An exacerbation of COPD, periodic escalations of symptoms of cough, dyspnea and sputum production, is a major contributor to the worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and costs of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has recently accumulated about the prevention of acute exacerbations.
Methods: In recognition of the importance of the prevention of exacerbations in the life of a COPD patient, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. The 3 key clinical questions were developed using the PICO (population, intervention, comparator, and outcome of interest) format, that addressed the prevention of acute exacerbations of COPD were non-pharmacologic therapies, inhaled therapies, and oral therapies. We utilized recognized document evaluation tools to allow us to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendation in each PICO category in a balanced and unbiased fashion.
Results: The AECOPD Guideline is unique not only for the topic of the guideline, prevention of acute COPD exacerbations, but also for the first-in-kind partnership between two of the largest thoracic societies of North America. The Guidelines Oversight Committee (GOC) of the American College of Chest Physicians in partnership with the COPD Clinical Assembly of the Canadian Thoracic Society launched this project with the objective that a systematic review and critical evaluation of the published literature that was conducted by clinical experts and researchers in the field of COPD would lead to a series of recommendations to assist clinicians in their management of the COPD patient.
Conclusion: This guideline is unique because it provides an up-to-date, rigorous evidence-based analysis of current randomized controlled trial data regarding the prevention of COPD exacerbations.
PMID: 25321320 [PubMed - as supplied by publisher]