Prevention of Acute Exacerbations of COPD

Publication Date: April 1, 2015

Recommendations

In patients with COPD, we suggest administering the 23-valent pneumococcal vaccine as part of overall medical management but did not find sufficient evidence that pneumococcal vaccination prevents acute exacerbations of COPD. (2, C)
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In patients with COPD, we recommend administering the influenza vaccine annually to prevent acute exacerbations of COPD. (1, B)
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In patients with COPD, we suggest including smoking cessation counseling and treatment using best practices as a component of a comprehensive clinical strategy to prevent acute exacerbations of COPD. (2, C)
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In patients with moderate, severe, or very severe COPD who have had a recent exacerbation (ie, 4 weeks), we recommend pulmonary rehabilitation to prevent acute exacerbations of COPD. (1, C)
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In patients with moderate, severe, or very severe COPD who have had an exacerbation greater than the past 4 weeks, we do not suggest pulmonary rehabilitation to prevent acute exacerbations of COPD (2, B)
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In patients with COPD, we suggest that education alone should not be used for prevention of acute exacerbations of COPD. (, )

(Ungraded Consensus-Based Statement)

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In patients with COPD, we suggest that case manage ment alone should not be used for prevention of acute exacerbations of COPD. (, )

(Ungraded Consensus-Based Statement)

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In patients with COPD with a previous or recent history of exacerbations, we recommend education and case management that includes direct access to a health-care specialist at least monthly to prevent severe acute exacerbations of COPD, as assessed by decreases in hospitalizations. (1, C)
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In patients with moderate to severe COPD, we suggest education together with an action plan but without case management does not prevent severe acute exacerbations of COPD, as assessed by a decrease in ED visits or hospitalizations over a 12-month period. (2, C)
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For patients with COPD, we suggest education with a written action plan and case management for the prevention of severe acute exacerbations of COPD, as assessed by a decrease in hospitalizations and ED visits. (2, B)
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For patients with COPD, we suggest that telemonitoring compared with usual care does not prevent acute exacerbations of COPD, as assessed by decreases in emergency room visits, exacerbations, or hospitalizations over a 12-month period. (2, C)
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In patients with moderate to severe COPD, we recommend the use of long-acting β2-agonist compared with placebo to prevent moderate to severe acute exacerbations of COPD. (1, B)
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In patients with moderate to severe COPD, we recommend the use of a long-acting muscarinic antagonist compared with placebo to prevent moderate to severe acute exacerbations of COPD. (1, A)
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In patients with moderate to severe COPD, we recommend the use of long-acting muscarinic antagonists compared with long-acting β2-agonist to prevent moderate to severe acute exacerbations of COPD. (1, C)
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In patients with moderate to severe COPD, we suggest the use of a short-acting muscarinic antagonist compared with short-acting β2-agonist monotherapy to prevent acute mild-moderate exacerbations of COPD. (2, C)
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In patients with moderate to severe COPD, we suggest the use of short-acting muscarinic antagonist plus short-acting β2-agonist compared with shortacting β2-agonist alone to prevent acute moderate exacerbations of COPD. (2, B)
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In patients with moderate to severe COPD, we suggest the use of long-acting β2-agonist monotherapy compared with short-acting muscarinic antagonist monotherapy to prevent acute exacerbations of COPD. (2, C)
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In patients with moderate to severe COPD, we recommend the use of a long-acting muscarinic antagonist compared with a short-acting muscarinic antagonist to prevent acute moderate to severe exacerbations of COPD. (1, A)
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In patients with moderate to severe COPD, we suggest the combination use of a short-acting muscarinic antagonist plus long-acting β2-agonist compared with long-acting β2-agonist monotherapy to prevent acute mild to moderate exacerbations of COPD. (2, C)
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For patients with stable moderate, severe, and very severe COPD, we recommend maintenance combination inhaled corticosteroid/long-acting β2-agonist therapy (and not inhaled corticosteroid monotherapy) compared with placebo to prevent acute exacerbations of COPD. (1, B)
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For patients with stable moderate, severe, and very severe COPD, we recommend maintenance combination inhaled corticosteroid/long-acting β2-agonist therapy compared with long-acting β2-agonist monotherapy to prevent acute exacerbations of COPD. (1, C)
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For patients with stable moderate to very severe COPD, we recommend maintenance combination inhaled corticosteroid/long-acting β2agonist therapy compared with inhaled corticosteroid monotherapy to prevent acute exacerbations of COPD. (1, B)
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For patients with stable COPD, we recommend inhaled long-acting anticholinergic/long-acting β2-agonist therapy or inhaled long-acting anticholinergic monotherapy, since both are effective to prevent acute exacerbations of COPD. (1, C)
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For patients with stable COPD, we recommend maintenance combination of inhaled corticosteroid/ long-acting β2-agonist therapy or inhaled long-acting anticholinergic monotherapy, since both are effective to prevent acute exacerbations of COPD. (1, C)
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For patients with stable COPD, we suggest maintenance combination of inhaled long-acting anticholinergic/corticosteroid/long-acting β2-agonist therapy or inhaled long-acting anticholinergic monotherapy, since both are effective to prevent acute exacerbations of COPD. (2, C)
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For patients with moderate to severe COPD, who have a history of one or more moderate or severe COPD exacerbations in the previous year despite optimal maintenance inhaler therapy, we suggest the use of a long-term macrolide to prevent acute exacerbations of COPD. (2, A)
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For patients with an acute exacerbation of COPD in the outpatient or inpatient setting, we suggest that systemic corticosteroids be given orally or intravenously to prevent hospitalization for subsequent acute exacerbations of COPD in the first 30 days following the initial exacerbation. (2, B)
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For patients with an acute exacerbation of COPD in the outpatient or inpatient setting, we recommend that systemic corticosteroids not be given orally or intravenously for the sole purpose of preventing hospitalization due to subsequent acute exacerbations of COPD beyond the first 30 days following the initial acute exacerbation of COPD. (1, A)
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For patients with moderate to severe COPD with chronic bronchitis and a history of at least one exacerbation in the previous year, we suggest the use of roflumilast to prevent acute exacerbations of COPD. (2, A)
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For stable patients with COPD, we suggest treatment with oral slow-release theophylline twice daily to prevent acute exacerbations of COPD. (2, B)
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For patients with moderate to severe COPD and a history of two or more exacerbations in the previous 2 years, we suggest treatment with oral N-acetylcysteine to prevent acute exacerbations of COPD. (2, B)
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For stable outpatients with COPD who continue to experience acute exacerbations of COPD despite maximal therapy designed to reduce acute exacerbations of COPD, we suggest that oral carbocysteine could be used to prevent acute exacerbations where this therapy is available.

(Ungraded Consensus-Based Statement)

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For patients with moderate to severe COPD who are at risk for COPD exacerbations, we do not recommend using statins to prevent acute exacerbations of COPD. (1, B)
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Recommendation Grading

Disclaimer

Overview

Title

Prevention of Acute Exacerbations of COPD

Authoring Organization

Publication Month/Year

April 1, 2015

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations.

Target Patient Population

Patients with COPD

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D029424 - Pulmonary Disease, Chronic Obstructive, D011315 - Preventive Medicine, D014611 - Vaccination, D016540 - Smoking Cessation

Keywords

vaccination, smoking cessation, chronic obstructive pulmonary disease (COPD), COPD

Source Citation

DOI: https://doi.org/10.1378/chest.14-1676

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
285
Literature Search Start Date
January 30, 2013
Literature Search End Date
April 29, 2013