Abstract
BACKGROUND:COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations. METHODS:In recognition of the importance of preventing exacerbations in patients with COPD, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion. RESULTS:The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in the field of COPD would lead to a series of recommendations to assist clinicians in their management of the patient with COPD. CONCLUSIONS:This guideline is unique because it provides an up-to-date, rigorous, evidence-based analysis of current randomized controlled trial data regarding the prevention of COPD exacerbations.
| Original language | English |
|---|---|
| Pages (from-to) | 894-942 |
| Number of pages | 49 |
| Journal | Chest |
| Volume | 147 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 1 2015 |
Bibliographical note
Funding Information:Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Bourbeau received government grants for conducting the longitudinal population-based Canadian Cohort Obstructive Lung Disease (CanCOLD) study from the Canadian Institute of Health Research (CIHR) Rx&D collaborative program (AstraZeneca, Boehringer Ingelheim GmbH, GlaxoSmithKline plc, Merck Sharp & Dohme Corp, Nycomed, Novartis AG), Canadian Respiratory Research Network, Respiratory Health Network of the Fonds de recherche du Québec-Santé, and Research Institute of the McGill University Health Centre. Ms Diekemper is a codeveloper of the DART (Document and Appraisal Review Tool), which was used in the AECOPD Guideline to assess the quality of the systematic reviews that informed some of the recommendations. Dr Hernandez reports that his institution has received pharmaceutical company grant monies for research studies on which he has been an investigator, including CSL Behring, Boehringer Ingelheim GmbH, and Grifols International SA. His institution also has received grant monies for research studies for which he has been an investigator, including CIHR and Lung Association of Nova Scotia. He has participated in speaking activities, industry advisory committees, and other activities related to industry sources with the following pharmaceutical companies: Actelion Pharmaceuticals US, Inc; Almirall, SA; AstraZeneca; Boehringer Ingelheim GmbH; GlaxoSmithKline plc; Grifols; Intermune; Merck Sharp & Dohme Corp; and Novartis AG. Dr Balter has served over the past 3 years on advisory boards for and has presented at continuing education meetings for Almirall, SA; AstraZeneca; Boehringer Ingelheim GmbH; GlaxoSmithKline plc; Merck Frosst Canada Inc; Novartis AG; and Takeda Pharmaceutical Company Limited. Dr Bhutani receives university grant money, pharmaceutical grant money, grant money from government organizations in Canada and participates in speakers bureaus and speaks publicly on the topic of acute exacerbations of COPD. Dr Camp has received operating grant funding from CIHR, Canadian Lung Association, and Physiotherapy Foundation of Canada. She has received research infrastructure funding from the Canadian Foundation of Innovation and the British Columbia Lung Association and a scholar award from the Michael Smith Foundation of Health Research. She has received honoraria for speaking engagements from the Canadian Lung Association and the University of British Columbia Respiratory Division. Dr Celli's division has received grants from AstraZeneca to complete research studies. He has served on an advisory board or as a consultant to GlaxoSmithKline plc; Boehringer Ingelheim GmbH; Almirall, SA; AstraZeneca; Takeda Pharmaceutical Company Limited; and Novartis AG. Neither he nor any member of his family has shares or interest in any company. Dr Celli has not received or had any relationship with tobacco money. Dr Dechman speaks to health professionals about the management of COPD, including acute exacerbations of COPD, but does not gain financially from doing so. Dr Dransfield has served as a consultant for GlaxoSmithKline plc; Boehringer Ingelheim GmbH; and Ikaria, Inc. His institution has received research grant support from the American Heart Association; National Heart, Lung, and Blood Institute; GlaxoSmithKline plc; and Forest Laboratories, Inc, and has received contracted support for enrollment in clinical trials from Aeris; Boehringer Ingelheim GmbH; Boston Scientific Corporation; Janssen Biotech, Inc (formerly Centocor Biotech, Inc); GlaxoSmithKline plc; Forest Laboratories, Inc; Otsuka America Pharmaceutical, Inc; Pearl Therapeutics Inc; Pfizer, Inc; PneumRx, Inc; and Pulmonx. Dr Fiel has received grant support from the Cystic Fibrosis Foundation and grants for clinical trials from Vertex Pharmaceuticals Incorporated, Gilead, Novartis AG, and PTC Therapeutics. Dr Foreman is PI for the Forest ASCENT COPD study (LAS-MD-45). Dr Hanania serves as a consultant to Boehringer Ingelheim GmbH; Sunovion Pharmaceuticals Inc; Novartis AG; Mylan Inc; Pearl Therapeutics Inc; and Pfizer, Inc. Her institution receives grant support on her behalf from GlaxoSmithKline plc; Boehringer Ingelheim GmbH; Pfizer, Inc; Pearl Therapeutics Inc; and Sunovion Pharmaceuticals Inc. Dr Marchetti has served as principal investigator for a pharmaceutical-funded clinical trial with GlaxoSmithKline plc. Dr Marciniuk has provided consultation for Health Canada, the Public Health Agency of Canada, and the Saskatoon Health Region. He has received research funding (all held and managed by the University of Saskatchewan) from AstraZeneca; Boehringer Ingelheim GmbH; CIHR; Forest Laboratories Inc; the Lung Association of Saskatchewan; Novartis AG; Pfizer, Inc; Saskatchewan Health Research Foundation; and Schering-Plough Corporation. He holds fiduciary positions with the American College of Chest Physicians, the Chest Foundation, and the Lung Health Institute of Canada. Drs Criner, Ouellette, Goodridge, Ireland, Mularski, Road, and Stickland; Ms Curren; and Mr Ornelas have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Publisher Copyright:
© 2015 The American College of Chest Physicians
ASJC Scopus Subject Areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine