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Guideline Scope and Purpose
The purpose of this guideline is to provide primary care– relevant recommendations for the management of acute exacerbations of chronic obstructive pulmonary disease (COPD). The target audience includes family physicians and other primary care clinicians. The target patient population is adults with acute exacerbations of COPD.
Introduction
COPD is characterized by airflow limitation and chronic respiratory symptoms, including cough and shortness of breath. It affects around 15 million people in the United States and costs more than $32 billion annually.1,2 Chronic lower respiratory tract diseases, including COPD, are the fourth leading cause of death in the United States and the third leading cause of death worldwide.3,4 Patients with COPD are at risk of acute exacerbations of symptoms resulting in the need for additional treatment. Acute exacerbations of COPD are generally characterized by increased dyspnea, increased frequency and severity of cough, and potentially increased sputum.5 Patients experiencing acute exacerbations of COPD are at increased risk of mortality and morbidity, lower quality of life, increased hospital admissions, and a progressive decline in lung function.6–13
The goals for management of acute exacerbations of COPD include symptom resolution and recovery from the exacerbation episode via improving airflow and gas exchange in addition to reducing lung inflammation. Prevention or reduction of severity of subsequent exacerbation episodes is also a goal for many management and prevention strategies. Typical interventions used for the management of COPD exacerbations include corticosteroids, systemic antibiotics, inhaled bronchodilators, and supplemental oxygen. Surprisingly, there is limited evidence for many of these treatments in this population.14 Recently, the role of mucolytics and aminophyllines has been studied based on their mechanism of action to aid in thinning and clearing of mucus and improving dyspnea, respectively.15,16
Several nonpharmacologic treatments have also been assessed for management and/or prevention of COPD exacerbations, including pulmonary rehabilitation programs, chest physiotherapy, and nutritional supplements. Chest physiotherapy includes the use of breathing techniques, vibration/percussion of the chest, and autogenic drainage (using breathing to loosen mucus). Vitamin D and omega-3 fatty acid supplements have also been highlighted as potential therapies for the prevention and management of acute exacerbations of COPD.14
Although much of the literature centers on inpatient treatment of patients with acute exacerbations of COPD, most U.S. patients with COPD are managed by...