The following recommendations are made: 1) a strong recommendation for the use of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy over LABA or LAMA monotherapy in patients with COPD and dyspnea or exercise intolerance; 2) a conditional recommendation for the use of triple therapy with inhaled corticosteroids (ICS)/LABA/LAMA over dual therapy with LABA/LAMA in patients with COPD and dyspnea or exercise intolerance who have experienced one or more exacerbations in the past year; 3) a conditional recommendation for ICS withdrawal for patients with COPD receiving triple therapy (ICS/LABA/LAMA) if the patient has had no exacerbations in the past year; 4) no recommendation for or against ICS as an additive therapy to long-acting bronchodilators in patients with COPD and blood eosinophilia, except for those patients with a history of one or more exacerbations in the past year requiring antibiotics or oral steroids or hospitalization, for whom ICS is conditionally recommended as an additive therapy; 5) a conditional recommendation against the use of maintenance oral corticosteroids in patients with COPD and a history of severe and frequent exacerbations; 6) a conditional recommendation for opioid-based therapy in patients with COPD who experience advanced refractory dyspnea despite otherwise optimal therapy.
Updated Global Initiative for Obstructive Lung Disease (GOLD) strategy for the Management and Prevention of Chronic Obstructive Pulmonary Disease.
U.K. National Institute for Health and Clinical Excellence (NICE) guideline covers diagnosing and managing chronic obstructive pulmonary disease or COPD (which includes emphysema and chronic bronchitis) in people aged 16 and older. It aims to help people with COPD to receive a diagnosis earlier so that they can benefit from treatments to reduce symptoms, improve quality of life and keep them healthy for longer.
Provides clinical recommendations for treatment of COPD exacerbations: (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.
Clinical guideline for the prevention of exacerbations of COPD with recommendations for mucolytic, long-acting muscarinic antagonist, phosphodiesterase-4 inhibitor (roflumilast) and macrolide therapy, as well as a conditional recommendation against fluoroquinolone therapy. All of the recommendations were conditional, except for a strong recommendation for the use of a long-acting antimuscarinic agent versus a long-acting β2-adrenergic, indicating that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention.
Pulmonary rehabilitation (PR) has demonstrated physiological, symptom-reducing, psychosocial, and health economic benefits for patients with chronic respiratory diseases, yet it is underutilized worldwide. The aim of this statement is to enhance the implementation, use, and delivery of pulmonary rehabilitation to suitable individuals.
This American Thoracic Society and European Respiratory Society statement reviews limb muscle dysfunction which is a key systemic consequence of COPD impacting on physical activity, exercise tolerance, quality of life, and even survival.
Pulmonary rehabilitation reduces breathlessness, increases exercise capacity, and improves quality of life in patients with chronic obstructive pulmonary disease (COPD). This Statement from the American Thoracic society and European Respiratory society provides a detailed update in the science and evolution of the concept of pulmonary rehabilitation.
Current evidence on the efficacy of insertion of endobronchial valves for lung volume reduction in emphysema shows some clinical and quality-of-life benefits. The U.K. National Institute for Health and Clinical Excellence (NICE) recommends they should only be used with special arrangements for clinical governance, consent and audit or research.
Canadian Thoracic Society (CTS) guidelines on quality of spirometry testing in primary care
UK National Institute for Health and Clinical Excellence (NICE) technology appraisal guideline recommends that Roflumilast is used only as part of a clinical trial for adults with severe chronic obstructive pulmonary disease (COPD) (post-bronchodilator FEV1 < 50% predicted) with a history of frequent exacerbations as an add-on to bronchodilator treatment.
A Canadian Thoracic Society clinical practice evidence based guideline. This statement supports targeted testing for A1AT deficiency in patients with COPD diagnosed before 65 years of age or with a smoking history of less than 20 pack years.
This document from the American Thoracic Society discuss the problems faced in the care of patients with COPD, defines the interrelated concepts of integrated care and chronic disease management as they may apply to this disease, and present strategies currently in use.
This quality standard from the U.K. National Institute for Health and Clinical excellence covers the assessment, diagnosis and clinical management of chronic obstructive pulmonary disease (COPD) in adults and describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with COPD.
UK National Institute for Health and Clinical Excellence (NICE) guide for commissioners, clinicians and managers to commission high quality and evidence based services across England.
A Clinical Practice Guideline Update from the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society(ERS) on the diagnosis and management of stable Chronic Obstructive Pulmonary disease.
IMPRESS is a joint initiative between the British Thoracic Society (BTS) and the Primary Care Respiratory Society-UK (PCRS-UK). This evidence based document explains what Pulmonary Rehabilitation is, how it works, its value and why it should be commissioned.
A Canadian Thoracic Society clinical evidence based practice guideline supports the benefits of oral opioids, neuromuscular electrical stimulation, chest wall vibration, walking aids and pursed-lip breathing in the management of dyspnea in patients with advanced COPD. Oxygen is recommended for COPD patients with resting hypoxemia who receive symptomatic benefit from it.
An American Thoracic Society (ATS) Public Policy Statement reviewing the literature evaluating the impact of risk factors other than cigarette smoking for COPD
A Canadian Thoracic Society evidence based Clinical Practice Guideline. Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease – practical issues.