Practice Guidelines

ACCP/CTS Provide Guidance on Preventing Acute COPD Exacerbations


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Am Fam Physician. 2015 Sep 1;92(5):399-401.

Key Points for Practice

• Smoking cessation counseling and therapy are suggested for persons with COPD as one piece of an overall plan to prevent exacerbations.

• Pulmonary rehabilitation improves quality of life, exercise tolerance, and dyspnea, and reduces the risk of readmission in patients with COPD who have had a recent exacerbation.

• Annual influenza vaccination and 23-valent pneumococcal vaccination are recommended, although evidence to support the role of the pneumococcal vaccine in reducing acute COPD exacerbations is insufficient.

• A long-acting anticholinergic alone; a long-acting anticholinergic combined with LABAs; or maintenance therapy with inhaled corticosteroids combined with LABAs is recommended for patients with stable COPD.

From the AFP Editors

Chronic obstructive pulmonary disease (COPD) can affect a patient's daily activities and quality of life, has significant morbidity and mortality, and is the third leading cause of death in the United States. It is associated with many health care expenses (e.g., office and emergency department visits, hospitalizations). Although not well understood, exacerbations cause most of the morbidity, mortality, and expenses. Few recommendations for preventive measures have been provided. The American College of Chest Physicians (ACCP) and Canadian Thoracic Society (CTS) have released a guideline with suggestions and recommendations for preventing COPD exacerbations based on available evidence.

Nonpharmacologic Options

There are a variety of nonpharmacologic measures (i.e., smoking cessation programs; pulmonary rehabilitation; education, action plans, and case management; and telemonitoring) and vaccinations (i.e., pneumococcal and influenza) to prevent acute exacerbations of COPD. Although some may provide benefit in certain patients, there are insufficient data to make definitive recommendations regarding their use.


Based on its health benefits in the general population, smoking cessation counseling and therapy (e.g., recognizing current smoking habits, cessation advice, medications [e.g., nicotine replacement, antidepressants]) are suggested for persons with COPD as one piece of an overall plan to prevent exacerbations. Smoking cessation is supported for multiple reasons, including evidence that it improves prognosis, that persons with mild disease who smoked and have cough or phlegm had fewer symptoms in the first year after quitting, and that some infections (e.g., pneumonia) can be linked to smoking.


Pulmonary rehabilitation improves quality of life, exercise tolerance, and dyspnea, and reduces the risk of readmission in persons with moderate to very severe COPD who have had a recent exacerbation (hospitalization within the past four weeks). However, rehabilitation is not suggested to prevent exacerbations for those whose last exacerbation was more than four weeks ago.


In persons with COPD and a history of exacerbations, education combined with case management is recommended to prevent severe exacerbations; this

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Medical Editor.

A collection of Practice Guidelines published in AFP is available at


Copyright © 2015 by the American Academy of Family Physicians.
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