Wedzicha JA, Calverley PMA, Albert RK, et al. Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir. J. 2017; 50:1602265.
Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017; 49:1600791.
The guidelines were a cooperative effort among the American Thoracic Society and the European Respiratory Society.
Methodology
Number of Source Documents
89
Literature Search Start Date
January 1, 2003
Literature Search End Date
September 30, 2020
Description of External Review Process
Described in ATS Methodology Manual.
Specialties Involved
Family Medicine, Geriatric Medicine, Internal Medicine General, Preventive Medicine, Pulmonology
Description of Systematic Review
Described in ATS Methodology Manual.
List of Questions
For the following six
questions, we employed a systematic review of the literature followed by the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) approach to develop treatment recommendations.
1) Should oral corticosteroids be used to treat ambulatory patients who are having a COPD exacerbation?
2) Should antibiotics be used to treat ambulatory patients who are having a COPD exacerbation?
3) Should intravenous or oral corticosteroids be used to treat patients who are hospitalised with a COPD
exacerbation?
4) Should NIV be used in patients who are hospitalised with a COPD exacerbation associated with acute
or acute-on-chronic respiratory failure?
5) Should a home-based management programme (hospital-at-home) be implemented in patients with
COPD exacerbations?
6) Should pulmonary rehabilitation be implemented in patients hospitalised with a COPD exacerbation?
Description of Search Strategy
Our literature searches used the National Institute of Health and Clinical Excellence (NICE) guidelines as a starting point [5, 7]. For questions that were addressed in the 2004 NICE guidelines, we conducted literature searches in Medline, Embase and the Cochrane Database of Systematic Reviews beginning in 2003. For questions that were addressed in the 2010 NICE guidelines, we conducted literature searches in the same databases beginning in 2009. Initial searches were conducted in January 2012, and then updated in June 2012, February 2013 and September 2015. We used the same or similar search strategies as those used by NICE. To search Embase and Medline, we searched only the English-speaking literature using the search strategy shown in the online supplement, whereas to search the Cochrane Database of Systematic Reviews, we used the search term “chronic
0bstructive pulmonary disease”.
Description of Study Selection
The lead methodologist screened the titles and abstracts of the retrieved studies, and excluded studies on the basis of the pre-defined study selection criteria shown in the online supplement. For those studies that could not be excluded by the title and abstract, we obtained the full text of the articles and then included or excluded the studies on the basis of our full text review. In cases of uncertainty, the opinions of the co-chairs and panellists were obtained and decisions were reached by discussion and consensus. We also screened the reference lists from recent and systematic reviews to ensure that our literature review had not
missed relevant studies.
Description of Evidence Analysis Methods
Described in ATS Methodology Manual.
Description of Evidence Grading
Described in ATS Methodology Manual.
Description of Recommendation Grading
GRADE rates the certainty (also known as quality or confidence) in effect estimates for benefits and harms as high, moderate, low or very low, and the overall certainty is based on the lowest confidence of the outcomes critical for decision making. Recommendations are classified as strong (desirable consequences clearly do or do not outweigh undesirable consequences) or conditional (the balance of desirable and undesirable consequences is less certain). Alternative designations are conditional, discretionary, or contingent recommendations.
A strong recommendation was made for an intervention when, following deliberations, the panel was certain that the desirable consequences of the intervention outweigh the undesirable consequences, likewise a strong recommendation would have been made against a proposed intervention if the panel was certain that the undesirable consequences of the intervention outweigh the desirable consequences. A strong recommendation indicates that almost all well-informed patients would choose to have or not to have the intervention.
A conditional recommendation was made for an intervention when the panel was uncertain whether the desirable consequences of the intervention outweigh the undesirable consequences, likewise a conditional recommendation would have been made against a proposed intervention if the panel was uncertain that the undesirable consequences of the intervention outweigh the desirable consequences. Reasons for a conditional recommendation and thus uncertainty included low or very low quality of evidence, or the desirable and undesirable consequences being finely balanced, with underlying values and preferences playing an important role.
Description of Funding Source
ATS provides funding for Guideline Development.
Company/Author Disclosures
States Disclosures in Journal. Note: Paywall prevents confirmation.