Key Points
➤ Chronic obstructive pulmonary disease (COPD) is a major cause of
morbidity and mortality in the world and is the fourth leading cause of
death in the United States.
➤ To date, the only therapeutic interventions known to reduce mortality in
COPD are smoking cessation and long-term treatment with continuous
supplemental oxygen for patients who have severe hypoxemia at rest.
➤ Recently, interest in the use of noninvasive ventilation (NIV) in chronic
hypercapnic COPD has been renewed with studies of so-called "high-
intensity" NIV, which refers to inspiratory pressures higher than those
used in most previous randomized controlled trials (RCTs) as well as
controlled ventilation with higher-than-baseline respiratory rates to
maximally reduce the PaCO
2
.
Application of Guideline Recommendations for Different
Stakeholders
Strong Recommendation
("e ATS recommends...")
Conditional Recommendation
("e ATS suggests...")
For
Patients
Most individuals in this situation
would want the recommended course
of action, and only a small proportion
would not.
e majority of individuals in this
situation would want the suggested
course of action, but many would not.
For
Clinicians
Most individuals should receive
the recommended course of action.
Adherence to this recommendation
according to the guideline could be used
as a quality criterion or performance
indicator. Formal decision aids are not
likely to be needed to help individuals
make decisions consistent with their
values and preferences.
Different choices are likely to be
appropriate for different patients
and therapy should be tailored to the
individual patient's circumstances.
ose circumstances may include
the patient's or family's values and
preferences.
For Policy
makers
e recommendation can be adapted as
policy in most situations, including for
use as performance indicators.
Policy making will require substantial
debates and involvement of many
stakeholders. Policies are also more
likely to vary between regions.
Performance indicators would have
to focus on the fact that adequate
deliberation about the management
options has taken place.
ese guidelines were created using the GRADE (Grading of Recommendations, Assessment,
Development and Evaluation) Working Group criteria.
