scholarly journals Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

2017 ◽  
Vol 49 (3) ◽  
pp. 1600791 ◽  
Author(s):  
Jadwiga A. Wedzicha ◽  
Marc Miravitlles ◽  
John R. Hurst ◽  
Peter M.A. Calverley ◽  
Richard K. Albert ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Antibiotic Therapy ◽  
Pulmonary Rehabilitation ◽  
Task Force ◽  
Chronic Obstructive ◽  
Noninvasive Mechanical Ventilation ◽  
European Respiratory Society ◽  
Copd Exacerbations ◽  
Home Based ◽  
Hospitalised Patients

This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.

scholarly journals Core outcome set for the management of acute exacerbations of chronic obstructive pulmonary disease: the COS-AECOPD ERS Task Force study protocol

2020 ◽  
Vol 6 (3) ◽  
pp. 00193-2020
Author(s):  
Alexander G. Mathioudakis ◽  
Fekri Abroug ◽  
Alvar Agusti ◽  
Per Bakke ◽  
Konstantinos Bartziokas ◽  
...  
Keyword(s):  
Study Protocol ◽  
Task Force ◽  
Core Outcome Set ◽  
Measurement Instrument ◽  
Chronic Obstructive ◽  
Core Outcome ◽  
European Respiratory Society ◽  
Copd Exacerbations ◽  
Outcome Set ◽  
Multi Stakeholder

Randomised controlled trials (RCTs) on the management of COPD exacerbations evaluate heterogeneous outcomes, often omitting those that are clinically important and patient relevant. This limits their usability and comparability. A core outcome set (COS) is a consensus-based minimum set of clinically important outcomes that should be evaluated in all RCTs in specific areas of health care. We present the study protocol of the COS-AECOPD ERS Task Force, aiming to develop a COS for COPD exacerbation management, that could remedy these limitations.For the development of this COS we follow standard methodology recommended by the COMET initiative. A comprehensive list of outcomes is assembled through a methodological systematic review of the outcomes reported in relevant RCTs. Qualitative research with patients with COPD will also be conducted, aiming to identify additional outcomes that may be important to patients, but are not currently addressed in clinical research studies. Prioritisation of the core outcomes will be facilitated through an extensive, multi-stakeholder Delphi survey with a global reach. Selection will be finalised in an international, multi-stakeholder meeting. For every core outcome, we will recommend a specific measurement instrument and standardised time points for evaluation. Selection of instruments will be based on evidence-informed consensus.Our work will improve the quality, usability and comparability of future RCTs on the management of COPD exacerbations and, ultimately, the care of patients with COPD. Multi-stakeholder engagement and societal support by the European Respiratory Society will raise awareness and promote implementation of the COS.

scholarly journals The Use of Noninvasive Mechanical Ventilation for the Treatment of Acute Exacerbations of Copd in Canada

2005 ◽  
Vol 12 (3) ◽  
pp. 129-133 ◽  
Author(s):  
Jennifer Drummond ◽  
Brian Rowe ◽  
Lawrence Cheung ◽  
Irvin Mayers
Keyword(s):  
Mechanical Ventilation ◽  
Blood Pressure Monitoring ◽  
Respiratory Therapy ◽  
Chronic Obstructive ◽  
Routine Practice ◽  
Noninvasive Mechanical Ventilation ◽  
Noninvasive Blood Pressure ◽  
Copd Exacerbations ◽  
Life Saving ◽  
Acute Exacerbations

BACKGROUND: Noninvasive mechanical ventilation (NIMV) is accepted as a life-saving treatment for patients presenting to the emergency department and other acute care settings with severe exacerbations of chronic obstructive pulmonary disease (COPD).OBJECTIVE: It was hypothesized that there is marked national variability in the use of NIMV. Therefore, the use of NIMV for COPD exacerbations in urban centres across Canada was evaluated.METHODS: All Canadian hospitals affiliated with a university training program were surveyed, and a request for involvement in this survey was posted on the Canadian Society of Respiratory Therapy professional practice listserv. Survey information was received from all 33 sites (100%) that were contacted.RESULTS: Marked differences in the application of NIMV were identified across all regions in Canada, ranging from requiring extensive monitoring in the intensive care unit to application on a general internal medical unit with intermittent noninvasive blood pressure monitoring. There were sites that rarely used NIMV for COPD exacerbations and others where it was routine practice.CONCLUSIONS: NIMV is a life-saving treatment for acute exacerbations of COPD. Despite clear clinical evidence, its use has not penetrated throughout all the larger urban hospitals in Canada. This may be more problematic in sites without 24 h respiratory therapy support. There are barriers to the routine application of NIMV that can be overcome using established guidelines and available evidence.

Maintaining Effects of Pulmonary Rehabilitation at Home in Chronic Obstructive Pulmonary Disease: A Systematic Literature Review

2021 ◽  
pp. 108482232199037
Author(s):  
Duarte Pinto ◽  
Lissa Spencer ◽  
Soraia Pereira ◽  
Paulo Machado ◽  
Paulino Sousa ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Literature Review ◽  
Pulmonary Rehabilitation ◽  
Rehabilitation Program ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Maintenance Strategies ◽  
Rehabilitation Programs ◽  
Home Based ◽  
Pulmonary Rehabilitation Program

To systematize strategies that may support patients with Chronic Obstructive Pulmonary Disease to maintain the effects of pulmonary rehabilitation over time. This systematic literature review was conducted, and the evidence was electronically searched in the Web of Science, Scopus, and EBSCO databases. This review included randomized controlled clinical trials, published until September 2019, that addressed components of an unsupervised home-based pulmonary rehabilitation program, maintenance strategies following outpatient pulmonary rehabilitation programs, as well as data on outcomes for quality of life, exercise performance, and dyspnea. A final sample of 5 articles was obtained from a total of 1693 studies. Data for final synthesis were grouped into 2 categories: components of unsupervised home-based pulmonary rehabilitation programs and maintenance strategies. An unsupervised home-based pulmonary rehabilitation program should consist of an educational component, an endurance training component, and a strength training component. When patients are transferred to the home environment, it is important to include more functional exercises specifically adapted to the patient’s condition, goals, and needs.

scholarly journals Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial

2013 ◽  
pp. 537 ◽  
Author(s):  
Fernanda Dias ◽  
Malosa Luciana Maria Malosa Sampaio ◽  
Graziela Alves da Silva ◽  
Evelim LF Dantas Gomes ◽  
Eloisa Sanches Pereira do Nascimento ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Home Based

scholarly journals Home-based pulmonary rehabilitation for people with COPD: A qualitative study reporting the patient perspective

2017 ◽  
Vol 15 (2) ◽  
pp. 123-130 ◽  
Author(s):  
Aroub Lahham ◽  
Christine F McDonald ◽  
Ajay Mahal ◽  
Annemarie L Lee ◽  
Catherine J Hill ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Physical Fitness ◽  
Pulmonary Rehabilitation ◽  
Positive Impact ◽  
Chronic Obstructive ◽  
Structured Interviews ◽  
Obstructive Pulmonary Disease ◽  
Home Setting ◽  
Supervised Exercise ◽  
Home Based

This study aimed to document the perspective of patients with chronic obstructive pulmonary disease (COPD) who underwent home-based pulmonary rehabilitation (HBPR) in a clinical trial. In this qualitative study, open-ended questions explored participants’ views regarding HBPR. Thirteen semi-structured interviews were analysed using a thematic analysis approach. Major themes from interviews included the positive impact of HBPR on physical fitness, breathing and mood. Participants valued the flexibility and convenience of the programme. Participants also highlighted the importance of social support received, both from the physiotherapist over the phone and from family and friends who encouraged their participation. Reported challenges were difficulties in initiating exercise, lack of variety in training and physical incapability. While most participants supported the home setting, one participant would have preferred receiving supervised exercise training at the hospital. Participants also reported that HBPR had helped establish an exercise routine and improved their disease management. This study suggests that people with COPD valued the convenience of HBPR, experienced positive impacts on physical fitness and symptoms and felt supported by their community and programme staff. This highly structured HBPR model may be acceptable to some people with COPD as an alternative to centre-based pulmonary rehabilitation.

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