Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline
Six questions about the exacerbation itself, answered where the evidence allowed and left open where it did not. Oral corticosteroids are suggested over intravenous in the patient who can swallow, and the course is short: five days, not the two weeks that convention had settled on. Antibiotics are suggested in the exacerbation that needs hospital admission. Non-invasive ventilation is recommended for the patient whose exacerbation brings acidotic hypercapnic respiratory failure, which is the one recommendation here that changes who survives. Home-based management and a pulmonary rehabilitation programme begun within three weeks of discharge are both suggested. The register's two trials behind these recommendations are below.
This guideline cites 2 of the 35 landmark trials in our Pulmonology register.
How long a steroid course1
- 2013REDUCEPulmonology · COPD · Steroid durationReduction in the Use of Corticosteroids in Exacerbated COPD
Non-invasive ventilation in respiratory failure1
- 1995Brochard NIVPulmonology · COPD · NIVNoninvasive Ventilation for Acute Exacerbations of COPD