ATS Pharmacologic Management of Chronic Obstructive Pulmonary Disease Guideline Pocket Guide

Table 1. Implications of Strong and Conditional Recommendations

	Strong Recommendation (“The ATS recommends...”)	Conditional Recommendation (“The ATS suggests...”)
Patients	The overwhelming majority of individuals in this situation would want the recommended course of action, and only a small minority would not. (It is the right course of action for >95% of patients.)	Most individuals in this situation would want the suggested course of action, but many would not. (It is the right course of action for >50% of patients.)
Clinicians	The overwhelming majority of individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. (It is reasonable to recommend it strongly to patients and caregivers.)	Different choices will be appropriate for different patients, and the clinician must help each patient arrive at a management decision consistent with her or his values and preferences. Decision aids may be useful to help individuals make decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision. (Slow down, think about it, discuss it with the patient.)
Policy makers	The recommendation can be adopted as policy in most situations, including for use as a performance indicator. (The recommended course of action may be an appropriate performance measure.)	Policy making will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place. (The recommended course of action is not appropriate for a performance measure.)

Interpretation of strong and conditional (weak) recommendations

	Strong recommendation	Conditional (weak) recommendation
Patients	Most individuals in this situation would want the recommended course of action, and only a small proportion would not.	The majority of individuals in this situation would want the suggested course of action, but many would not.
Clinicians	Most individuals should receive the intervention. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	Recognize that different choices will be appropriate for individual patients and that you must help each patient arrive at a management decision consistent with his or her values and preferences. Decision aids may be useful in helping individuals to make decisions consistent with their values and preferences.
Policy makers	The recommendation can be adopted as policy in most situations.	Policymaking will require substantial debate and involvement of various stakeholders.

Abbreviations

ATS: American Thoracic Society

COPD: chronic obstructive pulmonary disease

ICS: inhaled corticosteroid(s)

LABA: long acting β 2 agonist

LAMA: long-acting muscarinic antagonist

QOL: quality of life

Source Citation

Nici, L., Mammen, M., Charbek, E., et al. Pharmacologic Management of COPD: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med, 2020;201(9), pp.e56–e69.

Disclaimer

This resource is for informational purposes only, intended as a quick-reference tool based on the cited source guideline(s), and should not be used as a substitute for the independent professional judgment of healthcare providers. Practice guidelines are unable to account for every individual variation among patients or take the place of clinician judgment, and the ultimate decision concerning the propriety of any course of conduct must be made by healthcare providers after consideration of each individual patient situation. Guideline Central does not endorse any specific guideline(s) or guideline recommendations and has not independently verified the accuracy hereof. Any use of this resource or any other Guideline Central resources is strictly voluntary.

Pharmacologic Management of Chronic Obstructive Pulmonary Disease

Key Points

Table 1. Implications of Strong and Conditional Recommendations

Treatment

Interpretation of strong and conditional (weak) recommendations

Abbreviations

Source Citation

Disclaimer