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Eur Respir J. 2017 Mar 15;49(3). pii: 1600791. doi: 10.1183/13993003.00791-2016. Print 2017 Mar.

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline.

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Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.
Pneumology Dept, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
UCL Respiratory, University College London, London, UK.
Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
Dept of Medicine, University of Colorado, Denver, Aurora, CO, USA.
University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, TX, USA.
Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Respiratory Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.
Dept of Internal Medicine, Christian-Albrechts University, Kiel and LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany.
Iberoamerican Cochrane Center, Barcelona, Spain.
2nd Dept of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
Dept of Medicine, Boston University School of Medicine, Boston, MA, USA.
University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.


This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.

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