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.
Cette recommandation cite 2 des 35 essais majeurs de notre registre de Pneumologie.
How long a steroid course1
- 2013REDUCEPneumo · BPCO · Durée de la corticothérapieChez 314 patients présentant une exacerbation de BPCO, 5 jours de prednisone 40 mg étaient non-inférieurs pour la ré-exacerbation à 180 jours par rapport à un traitement de 14 jours.
Non-invasive ventilation in respiratory failure1
- 1995Brochard NIVPneumo · BPCO · VNIChez 85 patients présentant une insuffisance respiratoire hypercapnique aiguë sur BPCO, la VNI par masque facial a réduit les intubations et la mortalité hospitalière par rapport au traitement standard.