Guideline offers recommendations to prevent acute COPD exacerbations

An evidence-based guideline from the American College of Chest Physicians and Canadian Thoracic Society offers recommendations on preventing exacerbations in patients with chronic obstructive pulmonary disease (COPD).

“This guideline is unique because a group of interdisciplinary clinicians who have special expertise in COPD clinical research and care led the development of the guideline process with the assistance of methodologists,” the guideline states.

An executive summary and the full guideline are online in the April CHEST.

Among the full set of 33 recommendations are the following:

• In patients with COPD, administer the influenza vaccine annually to prevent acute exacerbations of COPD (strong recommendation, moderate-quality evidence).
• In patients with COPD, administer the 23-valent pneumococcal vaccine as part of overall medical management, although there isn't sufficient evidence that it prevents acute exacerbations (weak recommendation, low- or very low-quality evidence).
• In patients with moderate, severe, or very severe COPD who have had an exacerbation within the previous 4 weeks, offer pulmonary rehabilitation to prevent acute exacerbations of COPD (strong recommendation, low- or very low-quality evidence).
• In patients with moderate, severe, or very severe COPD who have had an exacerbation prior to the past 4 weeks, do not offer pulmonary rehabilitation to prevent acute exacerbations of COPD (weak recommendation, moderate-quality evidence).
• In patients with COPD, include smoking cessation counseling and treatment as part of a comprehensive clinical strategy to prevent acute exacerbations of COPD (weak recommendation, low- or very low-quality evidence).

The guideline also addresses the use of inhaled corticosteroids and long- and short-acting muscarinic antagonists and beta2-agonists based on patients' severity of disease.