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      Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People’s Republic of China

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          Abstract

          Chronic obstructive pulmonary disease (COPD) is a common disease that severely threatens human health. Acute exacerbation of COPD (AECOPD) is a major cause of disease progression and death, and causes huge medical expenditures. This consensus statement represents a description of clinical features of AECOPD in the People’s Republic of China and a set of recommendations. It is intended to provide clinical guidelines for community physicians, pulmonologists and other health care providers for the prevention, diagnosis, and treatment of AECOPD.

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          Most cited references 34

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          Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.

           W MacNee,  ,  B Celli (2004)
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            Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study.

            Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation, and has many components including mucus hypersecretion, oxidative stress, and airway inflammation. We aimed to assess whether carbocisteine, a mucolytic agent with anti-inflammatory and antioxidation activities, could reduce the yearly exacerbation rate in patients with COPD. We did a randomised, double-blind, placebo-controlled study of 709 patients from 22 centres in China. Participants were eligible if they were diagnosed as having COPD with a postbronchodilator forced expiratory volume in 1 s (FEV(1)) to forced vital capacity (FVC) ratio (FEV(1)/FVC) of less than 0.7 and an FEV(1) between 25% and 79% of the predicted value, were aged between 40 and 80 years, had a history of at least two COPD exacerbations within the previous 2 years, and had remained clinically stable for over 4 weeks before the study. Patients were randomly assigned to receive 1500 mg carbocisteine or placebo per day for a year. The primary endpoint was exacerbation rate over 1 year, and analysis was by intention to treat. This trial is registered with the Japan Clinical Trials Registry (http://umin.ac.jp/ctr/index/htm) number UMIN-CRT C000000233. 354 patients were assigned to the carbocisteine group and 355 to the placebo group. Numbers of exacerbations per patient per year declined significantly in the carbocisteine group compared with the placebo group (1.01 [SE 0.06] vs 1.35 [SE 0.06]), risk ratio 0.75 (95% CI 0.62-0.92, p=0.004). Non-significant interactions were found between the preventive effects and COPD severity, smoking, as well as concomitant use of inhaled corticosteroids. Carbocisteine was well tolerated. Mucolytics, such as carbocisteine, should be recognised as a worthwhile treatment for prevention of exacerbations in Chinese patients with COPD.
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              Guidelines for the management of adult lower respiratory tract infections--summary.

               M Woodhead,  F. Blasi,  S Ewig (2011)
              This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2014
                25 April 2014
                : 9
                : 381-395
                Affiliations
                [1 ]Department of Pulmonary Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
                [2 ]Southern Medical University South Hospital, Guangzhou, People’s Republic of China
                [3 ]The First Affiliated Hospital of Guangzhou Medical College and Guangzhou Institute of Respiratory Diseases, Guangzhou, People’s Republic of China
                [4 ]Affiliate Hospital of Inner Mongolia Medical University, Huhehaote, People’s Republic of China
                [5 ]Huaxi Hospital of Sichuan University, Chendu, People’s Republic of China
                [6 ]Zhongshan Hospital, Shanghai Medical College, Fudan University and Shanghai Respiratory Research Institute, Shanghai, People’s Republic of China
                [7 ]Ruijing Hospital of Shanghai Jiaotong University, Shanghai, People’s Republic of China
                [8 ]The First Affiliated University of Anhui Medical University, Hefei, People’s Republic of China
                [9 ]The First Affiliated University of Guangxi Medical University, Nanning, People’s Republic of China
                [10 ]Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
                [11 ]General Hospital of Nanjing Military Region, Nanjing, People’s Republic of China
                [12 ]Beijing Hospital of the Ministry of Health, Beijing, People’s Republic of China
                [13 ]Xinqiao Hospital, Third Military Medical University, Chongqing, People’s Republic of China
                [14 ]Qilu Hospital of Shandong University, Jinan, People’s Republic of China
                [15 ]Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
                [16 ]The Second Affiliated Hospital of Hebei Medical University and Hebei Research Institute of Respiratory Medicine, Shijiazhuang, People’s Republic of China
                [17 ]The Third Affiliated Hospital of Beijing University, Beijing, People’s Republic of China
                [18 ]The First Affiliated University of Lanzhou University, Lanzhou, People’s Republic of China
                Author notes
                Correspondence: Chun-xue Bai, 180 Fenglin Road, Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai, 200032, People’s Republic of China, Email bai.chunxue@ 123456zs-hospital.sh.cn
                Article
                copd-9-381
                10.2147/COPD.S58454
                4008287
                24812503
                © 2014 Cai et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Expert Opinion

                Respiratory medicine

                recommendations, aecopd, copd, guidelines

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