Treatment of Chronic Obstructive Pulmonary Disease Exacerbations: Guidelines from the American Academy of Family Physicians
Am Fam Physician. 2021 Jul ;104(1):100-101.
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Key Points for Practice
• Systemic corticosteroids prevent clinical failure in COPD exacerbations. Treatment for 10 days or longer increases adverse effects and may not be more effective than treatment for three to five days.
• Antibiotics for seven days increase clinical cure in COPD exacerbations with an NNT of 7.
• Magnesium, theophyllines, and mucolytics do not improve outcomes in COPD exacerbations, and bronchodilators had no benefit in limited studies.
From the AFP Editors
Approximately 15 million Americans are affected by chronic obstructive pulmonary disease (COPD), with airflow limitations, cough, and shortness of breath. Chronic respiratory diseases, including COPD, are the fourth leading cause of death in the United States. Acute exacerbations of COPD increase mortality and hospital admissions while reducing lung function and quality of life. Despite this risk, evidence is limited for treating exacerbations. The American Academy of Family Physicians (AAFP) has published guidelines for treating acute exacerbations of COPD based on a systematic review.
In acute exacerbations, systemic corticosteroids reduce exacerbations with a number needed to treat (NNT) of 3 to prevent clinical failure. Clinical failure is defined as the lack of significant clinical improvement or the need for additional therapy. This is based on only two randomized controlled trials with 286 patients, yet there were no clinical failures in the corticosteroid group of either study. The evidence is low quality due to the high risk of bias and imprecision in both studies. Adverse events are not significantly increased with corticosteroid therapy. Treatment for 10 to 14 days may not provide greater benefit over treatment for three to five days. A large retrospective study of more than 10,000 patients demonstrated small increases in hospitalization for pneumonia and mortality with longer corticosteroid courses.
Antibiotic therapy also improves outcomes in acute
This series is coordinated by Michael J. Arnold, MD, contributing editor.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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