Currently Viewing:
Newsroom
Currently Reading
Lack of Payer Support a Barrier to Diabetes Prevention, CDC Reports
December 17, 2017 – Mary Caffrey
Pfizer Announces Phase 3 Trial for Atopic Dermatitis Treatment
December 15, 2017 – Samantha DiGrande
Average Profit Margin on Oncology Drugs For 340B Hospitals Nears 50%
December 15, 2017 – Jaime Rosenberg
Majority of Women With Breast Cancer Surgery Did Not Feel Fully Informed of Treatment Options
December 15, 2017 – Jaime Rosenberg
AJMC® in the Press, December 15, 2017
December 15, 2017 – AJMC Staff
What We're Reading: Medicare Lab Testing; CHIP Deadline; AMA Expands Diabetes Efforts
December 15, 2017 – AJMC Staff
5 Key Takeaways From ASH 2017
December 15, 2017 – Surabhi Dangi-Garimella, PhD
This Week in Managed Care: December 15, 2017
December 15, 2017
What We're Reading: Medical Device Tax; Marijuana and Vaping; Birth Control Without Prescriptions
December 14, 2017 – AJMC Staff

European, American Societies Provide Guidelines for Managing COPD Exacerbations

Laura Joszt
The European Respiratory Society and the American Thoracic Society have conducted a comprehensive review of evidence of managing exacerbations of chronic obstructive pulmonary disease in order to create a guideline of clinical recommendations.
The European Respiratory Society and the American Thoracic Society have conducted a comprehensive review of evidence on managing exacerbations of chronic obstructive pulmonary disease (COPD) in order to create a guideline of clinical recommendations. The guideline was published in the European Respiratory Journal.

The Task Force appraised evidence from clinical trials that was relevant to the 6 questions it wanted to develop treatment recommendations for.

“These guidelines provide the basis for rational decisions in the treatment of COPD exacerbations,” the authors wrote.

1. Should oral corticosteroids be used to treat ambulatory patients who are having COPD exacerbation?

The Task Force identified 3 clinical trials in this area that had enrolled a total of 204 patients. A review of the trials found that oral corticosteroids for 9 to 14 days in outpatients experiencing COPD exacerbations results in improved lung function and reduces hospitalizations.
Recommendation: A short course of 14 days or fewer of oral corticosteroids for ambulatory patients with an exacerbation of COPD.
 

2. Should antibiotics be used to treat ambulatory patients who are having a COPD exacerbation?

A total of 2 trials with 483 enrolled participants were analyzed. While antibiotic therapy reduced the risk of treatment failure and increased the time between exacerbations, patients had a trend toward more adverse events.
Recommendation: Ambulatory patients with a COPD exacerbation should receive antibiotics, but selection of antibiotics should be based on local sensitivity patterns.
 

3. Should intravenous or oral corticosteroids be used to treat patients who are hospitalized with a COPD exacerbation?

The Task Force identified 2 trials with a total of 250 patients hospitalized with a COPD exacerbation. They found that there was not an observable difference in treatment failure, hospital readmission, or length of hospital stay between oral or intravenous corticosteroids. However, intravenous corticosteroids might increase the risk of adverse events.
Recommendation: Patients hospitalized because of a COPD exacerbation should receive oral rather than intravenous corticosteroids if gastrointestinal access and function are intact.
 

4. Should noninvasive mechanical ventilation be used in patients who are hospitalized with a COPD exacerbation associated with acute or acute-on-chronic respiratory failure?

A total of 21 trials were used to inform the Task Force’s judgement. Noninvasive mechanical ventilation reduced the need for intubation and decreased mortality, complications of therapy, and length of both hospital stay and intensive care unit stay for patients who were hospitalized due to a COPD exacerbation.
Recommendation: Patients with acute or acute-on-chronic respiratory failure due to COPD who are hospitalized should be given noninvasive mechanical ventilation.
 

5. Should a home-based management program be implemented in patients with COPD exacerbations?

The Task Force analyzed 9 trials comparing home-based management to usual care in patients with COPD exacerbations. The researchers found that the home-based management model reduced the number of readmissions and they identified a slight trend toward lower mortality. No adverse events were reported.
Recommendations: A home-based management program can be used for patients with a COPD exacerbation who present to the emergency department or hospital.
 

6. Should pulmonary rehabilitation be implemented in patients hospitalized with a COPD exacerbation?

A total of 13 trials implementing pulmonary rehabilitation were analyzed. The Task Force members found that pulmonary rehabilitation initiated during hospitalization increased exercise capacity, while rehabilitation initiated within 3 weeks of discharge reduced readmissions and quality of life. Rehabilitation initiated within 8 weeks of discharge increased exercise capacity.
Recommendations: Pulmonary rehabilitation should be initiated within 3 weeks of being discharged for patients who were hospitalized with a COPD exacerbation. The Task Force does not recommend initiating rehabilitation while patients are still hospitalized.
 

The recommendation regarding noninvasive mechanical ventilation was the only one to receive a strong recommendation, while conditional recommendations were made for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalized patients, antibiotic therapy, home-based management, and initiation of pulmonary rehabilitation within 3 weeks of hospital discharge.

However, it is important to note that there was sparse evidence in several areas.

“These recommendations should be reconsidered as new evidence becomes available,” the authors wrote.

 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!