CHEST Guidelines-Prevention of Acute Exacerbations of COPD

Prevention of Acute Exacerbations of COPD

Pdf Summary

The 2015 guideline by the American College of Chest Physicians and Canadian Thoracic Society focuses on the prevention of acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD). It emphasizes COPD as a significant cause of morbidity and mortality, exacerbations of which often lead to decreased lung function and increased healthcare costs.

Key recommendations include:

1. <strong>Pneumococcal and Influenza Vaccination</strong>: Administering the pneumococcal vaccine is encouraged but lacks strong evidence for preventing exacerbations. However, annual influenza vaccinations are recommended to lower exacerbation risk.

2. <strong>Smoking Cessation</strong>: Emphasized as a key intervention, smoking cessation is one of the few evidence-based measures that slow lung function decline in COPD patients.

3. <strong>Pulmonary Rehabilitation</strong>: Recommended for patients with recent exacerbations to reduce hospitalizations but not suggested for those beyond four weeks post-exacerbation.

4. <strong>Nonpharmacologic Therapies</strong>: While education alone or case management may not prevent exacerbations, combining them with direct specialist access can reduce hospitalizations.

5. <strong>Inhaled Therapies</strong>: Long-acting bronchodilators, like long-acting beta-agonists and muscarinic antagonists, are recommended to reduce exacerbation risk. Combined inhaled corticosteroids and long-acting beta-agonist therapy improve outcomes but carry pneumonia risk.

6. <strong>Oral Therapies</strong>: Use of macrolides is suggested for patients with frequent exacerbations, focusing on its benefits despite the potential for antibiotic resistance and hearing loss. Long-term use of systemic corticosteroids is not recommended due to significant adverse effects outweighing benefits.

Overall, these guidelines underscore the importance of specific vaccinations, smoking cessation, inhaled therapies, and selected oral treatments in reducing COPD exacerbations, emphasizing an evolving understanding but also highlighting areas for further research.

Keywords

COPD

acute exacerbations

pneumococcal vaccination

influenza vaccination

smoking cessation

pulmonary rehabilitation

nonpharmacologic therapies

inhaled therapies

oral therapies

American College of Chest Physicians