| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
* From the Center for Clinical Health Policy Research (Drs. McCrory and Brown), Duke Evidence-Based Practice Center and Duke University Medical Center, Durham, NC; and the Department of Epidemiology and Biostatistics (Ms. Gelfand and Dr. Bach), Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, New York, NY. This paper also appeared in Annals of Internal Medicine 2001; 134:600–620.
Correspondence to: Peter B. Bach, MD, MAPP, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 221, New York, NY 10021.
Study objectives: To critically review the available data on the diagnostic evaluation, risk stratification, and therapeutic management of patients with acute exacerbations of COPD.
Design, setting, and participants: English-language articles were identified from the following databases: MEDLINE (from 1966 to week 5, 2000), EMBASE (from 1974 to week 18, 2000), HealthStar (from 1975 to June 2000), and the Cochrane Controlled Trials Register (2000, issue 1). The best available evidence on each subtopic then was selected for analysis. Randomized trials, sometimes buttressed by cohort studies, were used to evaluate therapeutic interventions. Cohort studies were used to evaluate diagnostic tests and risk stratification. Study design and results were summarized in evidence tables. Individual studies were rated as to their internal validity, external validity, and quality of study design. Statistical analyses of combined data were not performed.
Measurement and results: Limited data exist regarding the utility of most diagnostic tests. However, chest radiography and arterial blood gas sampling appear to be useful, while short-term spirometry measurements do not. In terms of the risk of relapse and the risk of death after hospitalization for an acute exacerbation, there are identifiable clinical variables that are associated with these outcomes. Therapies for which there is evidence of efficacy include bronchodilators, corticosteroids, and noninvasive positive-pressure ventilation. There is also support for the use of antibiotics in patients with more severe exacerbations. Based on limited data, mucolytics and chest physiotherapy do not appear to be of benefit, and oxygen supplementation appears to increase the risk of respiratory failure in an identifiable subgroup of patients.
Conclusions: Although suggestions for appropriate management can be made based on available evidence, the supporting literature is spotty. Further high-quality research is needed and will require an improved, generally acceptable, and transportable definition of the syndrome "acute exacerbation of COPD" and improved methods for observing and measuring outcomes.
This article has been cited by other articles:
|
|
 |
|
  I. E. Rascon-Aguilar, M. Pamer, P. Wludyka, J. Cury, D. Coultas, L. R. Lambiase, N. S. Nahman, and K. J. Vega Role of Gastroesophageal Reflux Symptoms in Exacerbations of COPD. Chest, October 1, 2006; 130(4): 1096 - 1101. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Lindenauer, P. Pekow, S. Gao, A. S. Crawford, B. Gutierrez, and E. M. Benjamin Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med, June 20, 2006; 144(12): 894 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E Hollandl and B. M Buttonl Is there a role for airway clearance techniques in chronic obstructive pulmonary disease? Chronic Respiratory Disease, April 1, 2006; 3(2): 83 - 91. [Abstract] [PDF]
|
|
|
|
 |
|
 S. F. Vondracek and B. A. Hemstreet Retrospective evaluation of systemic corticosteroids for the management of acute exacerbations of chronic obstructive pulmonary disease Am. J. Health Syst. Pharm., April 1, 2006; 63(7): 645 - 652. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Braman Chronic Cough Due to Acute Bronchitis: ACCP Evidence-Based Clinical Practice Guidelines Chest, January 1, 2006; 129(1_suppl): 95S - 103S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Braman Chronic Cough Due to Chronic Bronchitis: ACCP Evidence-Based Clinical Practice Guidelines Chest, January 1, 2006; 129(1_suppl): 104S - 115S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Woodhead, F. Blasi, S. Ewig, G. Huchon, M. Leven, A. Ortqvist, T. Schaberg, A. Torres, G. van der Heijden, and T. J. M. Verheij Guidelines for the management of adult lower respiratory tract infections Eur. Respir. J., December 1, 2005; 26(6): 1138 - 1180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Calverley, R. Pauwels{dagger}, C-G. Lofdahl, K. Svensson, T. Higenbottam, L-G. Carlsson, and E. Stahl Relationship between respiratory symptoms and medical treatment in exacerbations of COPD Eur. Respir. J., September 1, 2005; 26(3): 406 - 413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Fujimoto, M. Yasuo, K. Urushibata, M. Hanaoka, T. Koizumi, and K. Kubo Airway inflammation during stable and acutely exacerbated chronic obstructive pulmonary disease Eur. Respir. J., April 1, 2005; 25(4): 640 - 646. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Lode, J. Eller, A. Linnhoff, M. Ioanas, and the Evaluation of Therapy-Free Interval in COPD Pa Levofloxacin versus clarithromycin in COPD exacerbation: focus on exacerbation-free interval Eur. Respir. J., December 1, 2004; 24(6): 947 - 953. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Donohue and J. A. Ohar Effects of Corticosteroids on Lung Function in Asthma and Chronic Obstructive Pulmonary Disease Proceedings of the ATS, November 1, 2004; 1(3): 152 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. H. Bailey The Dyspnea-Anxiety-Dyspnea Cycle--COPD Patients' Stories of Breathlessness: "It's Scary /When you Can't Breathe" Qual Health Res, July 1, 2004; 14(6): 760 - 778. [Abstract] [PDF]
|
|
|
|
|
|
R. Buhl and S. G. Farmer Current and Future Pharmacologic Therapy of Exacerbations in Chronic Obstructive Pulmonary Disease and Asthma Proceedings of the ATS, April 1, 2004; 1(2): 136 - 142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Murphy, M. McKechnie, and J. Dunning Antibiotics in acute exacerbations of chronic obstructive pulmonary disease Emerg. Med. J., March 1, 2004; 21(2): 200 - 203. [Abstract] [Full Text]
|
|
|
|
|
|
S. Kim, C. L. Emerman, R. K. Cydulka, B. H. Rowe, S. Clark, and C. A. Camargo Prospective Multicenter Study of Relapse Following Emergency Department Treatment of COPD Exacerbation Chest, February 1, 2004; 125(2): 473 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Foral, M. A. Malesker, G. Huerta, and D. E. Hilleman Nebulized Opioids Use in COPD Chest, February 1, 2004; 125(2): 691 - 694. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. R. Celli A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease JAMA, November 26, 2003; 290(20): 2721 - 2729. [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Irwin and J. M. Madison Systemic Corticosteroids for Acute Exacerbations of Chronic Obstructive Pulmonary Disease N. Engl. J. Med., June 26, 2003; 348(26): 2679 - 2681. [Full Text] [PDF]
|
|
|
|
|
|
N. A. Dewan COPD Exacerbations : To X-ray or Not To X-ray Chest, October 1, 2002; 122(4): 1118 - 1121. [Full Text] [PDF]
|
|
|
|
|
|
A. Ortqvist Treatment of community-acquired lower respiratory tract infections in adults Eur. Respir. J., July 1, 2002; 20(36_suppl): 40S - 53s. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Stoller Acute Exacerbations of Chronic Obstructive Pulmonary Disease N. Engl. J. Med., March 28, 2002; 346(13): 988 - 994. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
