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      Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline.

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          Abstract

          This document provides clinical recommendations for the prevention of chronic obstructive pulmonary disease (COPD) exacerbations. It represents a collaborative effort between the European Respiratory Society and the American Thoracic Society.Comprehensive evidence syntheses were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable (benefits) and undesirable consequences (burden in the form of adverse effects and cost), quality of evidence, feasibility, and acceptability of various interventions, the Task Force made recommendations for mucolytic, long-acting muscarinic antagonist, phosphodiesterase-4 inhibitor (roflumilast) and macrolide therapy, as well as a conditional recommendation against fluoroquinolone therapy. All of the recommendations were conditional, except for a strong recommendation for the use of a long-acting antimuscarinic agent versus a long-acting β2-adrenergic, indicating that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention.The guideline summarises the evidence and provides recommendations for pharmacological therapy for the prevention of COPD exacerbations.

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          Author and article information

          Journal
          Eur. Respir. J.
          The European respiratory journal
          European Respiratory Society (ERS)
          1399-3003
          0903-1936
          Sep 2017
          : 50
          : 3
          Affiliations
          [1 ] Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.
          [2 ] Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
          [3 ] Dept of Medicine, University of Colorado, Denver, Aurora, CO, USA.
          [4 ] University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, TX, USA.
          [5 ] Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
          [6 ] UCL Respiratory, University College London, London, UK.
          [7 ] Pneumology Dept, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain mmiravitlles@vhebron.net.
          [8 ] Respiratory Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.
          [9 ] Dept of Internal Medicine, Christian-Albrechts University, Kiel and LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany.
          [10 ] Iberoamerican Cochrane Center, Barcelona, Spain.
          [11 ] 2nd Dept of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
          [12 ] Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
          [13 ] Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
          [14 ] Dept of Medicine, Boston University School of Medicine, Boston, MA, USA.
          [15 ] University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
          Article
          50/3/1602265
          10.1183/13993003.02265-2016
          28889106

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