ATS GUIDELINES Bundle

COPD Exacerbations

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Key Points ➤ Prevention and management of exacerbations are key objectives in chronic obstructive pulmonary disease (COPD) management. ➤ Exacerbations are defined clinically as episodes of increasing respiratory symptoms, particularly dyspnea, cough and sputum production, and increased sputum purulence. ➤ Patients with recurrent hospitalizations for exacerbations experience greater impairment in health status and have reduced survival. ➤ Treatments that effectively reduce the frequency and/or severity of exacerbations may have an impact on quality of life, the progression and ultimately the prognosis of COPD. ➤ For ambulatory patients with an exacerbation of COPD, the Task Force suggests a short course (≤14 days) of oral corticosteroids (conditional recommendation, very low quality of evidence). ➤ For ambulatory patients with an exacerbation of COPD, the Task Force suggests the administration of antibiotics. Antibiotic selection should be based upon local sensitivity patterns (conditional recommendation, moderate quality of evidence). ➤ For patients who are hospitalized with a COPD exacerbation, the Task Force suggests the administration of oral corticosteroids rather than intravenous corticosteroids if gastrointestinal access and function are intact (conditional recommendation, low quality of evidence). ➤ For hospitalized patients with acute or acute-on-chronic hypercapnic respiratory failure due to a COPD exacerbation, the Task Force recommends the use of noninvasive mechanical ventilation (strong recommendation, low quality of evidence). ➤ For patients with a COPD exacerbation who present to the emergency department or hospital, the Task Force suggests a home-based management program (hospital-at-home) (conditional recommendation, moderate quality of evidence). ➤ For patients who are hospitalized with a COPD exacerbation, the Task Force suggests the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge (conditional recommendation, very low quality of evidence). ➤ For patients who are hospitalized with a COPD exacerbation, the Task Force suggests NOT initiating pulmonary rehabilitation during hospitalization (conditional recommendation, very low quality of evidence). Treatment

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