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Chest. 2015 Apr;147(4):894-942. doi: 10.1378/chest.14-1676.

Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline.

Author information

1
Temple University School of Medicine, Philadelphia, PA. Electronic address: gerard.criner@tuhs.temple.edu.
2
Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada.
3
American College of Chest Physicians, Glenview, IL.
4
Henry Ford Health System, Detroit, MI.
5
College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
6
Department of Medicine, Dalhousie University, Halifax, NS, Canada.
7
School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
8
Canadian Thoracic Society, Ottawa, ON, Canada.
9
Division of Respirology, University of Toronto, Toronto, ON, Canada.
10
University of Alberta, Edmonton, AB, Canada.
11
Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
12
Harvard Medical School, Brigham and Women's Hospital, Boston, MA.
13
University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, AL.
14
Medical Center/Atlantic Health System, Morristown, NJ.
15
Morehouse School of Medicine, Atlanta, GA.
16
Baylor College of Medicine, Houston, TX.
17
The Evidence Doc, Pacific, MO.
18
Temple University School of Medicine, Philadelphia, PA.
19
Division of Respirology, Critical Care and Sleep Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
20
Kaiser Permanente Center for Health Research, Portland, OR.
21
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
22
Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada.

Abstract

BACKGROUND:

COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost 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 accumulated about the prevention of acute exacerbations.

METHODS:

In recognition of the importance of preventing exacerbations in patients with COPD, 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. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion.

RESULTS:

The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature 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 patient with COPD.

CONCLUSIONS:

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
PMCID:
PMC4388124
DOI:
10.1378/chest.14-1676
[Indexed for MEDLINE]
Free PMC Article
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