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First Patient-Care Guidelines in Prevention of Acute Exacerbations in COPD

Medications and nonpharmacologic recommendations graded

New evidence-based guidelines released by the American College of Chest Physicians (CHEST) and the Canadian Thoracic Society (CTS) seek to prevent exacerbations of chronic obstructive pulmonary disease (COPD), which can cause frequent hospital readmissions, death, and greatly reduced quality of life for patients.

The recommendations are outlined in the “Prevention of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: American College of Chest Physicians and Canadian Thoracic Society Guideline,” published in the journal CHEST.

“Previous guidelines primarily address the management of COPD exacerbations. The prevention of acute exacerbations has not been a major focus until recently,” said Jean Bourbeau, MD, Guideline Vice-Chair and CTS member. “These new guidelines fill in the gaps that previously existed for prevention of exacerbations.”

The guidelines address old and new pharmacologic and nonpharmacologic therapies available for the prevention of COPD exacerbations and give grades to the recommendations.

According to the Centers for Disease Control and Prevention, COPD cost the U.S. an estimated $49.9 billion for 2010, and one study reported that hospitalizations due to exacerbations account for more than half of the cost of managing COPD.

“Our work in preventing exacerbations will help to improve the quality of lives for the millions living with this chronic condition. We hope it will also ease the financial burden associated with COPD,” said Gerard Criner, MD,Guideline Chair, CHEST member, and Director of the Temple Lung Center.

The guidelines analyze the efficacy of inhaled therapies to prevent COPD exacerbations, including short-acting and long-acting beta-2–agonists, short-acting and long-acting muscarinic antagonists, corticosteroids, and various combinations. Oral therapies are reviewed in the categories of antibiotics, oral corticosteroids, phosphodiesterase inhibitors, mucolytic agents, and statins.

Among the nonpharmacologicl recommendations, the guidelines say COPD patients should receive vaccines that help prevent influenza and pneumococcal disease, and that patients should receive smoking cessation counseling and treatment. Pulmonary rehabilitation is recommended for patients with moderate to very severe COPD who have had an exacerbation within the last four weeks.

Education, case management, and written action plans can also reduce severe, acute exacerbations — but these elements are more effective when combined and may not work alone.

Sources: CHEST; October 16, 2014; CHEST Guidelines Executive Summary; October 16, 2014.

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