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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