Levels of Evidence Evidence Category
A B C D
Sources of Evidence
Randomized controlled trials; rich body of data Randomized controlled trials; limited body of data Nonrandomized trials; observational studies Panel consensus judgment
Abbreviations ABG, arterial blood gases; AECOPD, acute exacerbations of COPD; AO, airflow obstruction; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; Evid, evidence; FEV1
forced expiratory volume in 1 second; FVC, forced vital capacity; ICS, inhaled corticosteroid; LAAC, long-acting anticholinergic; LABA, long-acting β-agonist; LABD, long-acting bronchodilator; MDI, metered dose inhaler; MRC, Medical Research Council Dyspnea Scale; Qual, quality; Rec, recommendation; SABA, short-acting β-agonist; SABD, short-acting bronchodilator
Sources
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Health Care Professionals. Updated 2010. Available at: www.goldcopd.org. Accessed July 26, 2011.
Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155:179-191.
Rodriguez-Roisin R. COPD exacerbations 5: Management. Thorax. 2006;61:535-544. * BLACK BOX WARNING: Long-acting β2
death. They should never be used alone in children or adults with asthma. Please see product labeling for information on this warning. An FDA Medication Guide should be distributed to patients starting a new prescription.
-adrenergic agonists may increase the risk of asthma-related ,
Disclaimer This Guideline attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.
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