Literature Review: Key Guidelines and Studies

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Guidelines

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report (2023)

Key Recommendations

• Use SABAs ± short-acting anticholinergics as preferred bronchodilators (Evidence A)
• Administer systemic corticosteroids 40-50 mg daily for 5 days (Evidence B)
• Give antibiotics empirically for purulent sputum/respiratory failure (Evidence B)
• Use non-invasive ventilation for respiratory acidosis (Evidence A)
• Implement lung-protective mechanical ventilation if needed (Evidence C)
• Consider home-based care for select patients if resources permit (Evidence B)

2. American Thoracic Society/European Respiratory Society Guidelines (2017)

Key Recommendations

• Use SABAs and SAMAs as first-line bronchodilators (Strong recommendation, moderate quality evidence)
• Give systemic corticosteroids for hospitalized patients (Strong recommendation, high quality evidence)
• Administer antibiotics if increased purulence/volume of sputum (Conditional recommendation, low quality evidence)
• Apply NIV for acute respiratory acidosis (Strong recommendation, high quality evidence)
• Do not use chest physiotherapy (Strong recommendation, high quality evidence)

3. National Institute for Health and Care Excellence (NICE) Guideline (2018)

Key Recommendations

• Use oral corticosteroids for exacerbations with significant breathlessness (Evidence level I)
• Give antibiotics if purulent sputum and increased dyspnea or sputum volume (Evidence level I)
• Offer NIV if respiratory acidosis despite optimized medical therapy (Evidence level I)
• Do not offer mucolytics routinely (Evidence level I)

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Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Review

CD013506.pdf (nih.gov)

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Select Trials

You be reviewing two important clinical trials related to the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD):

1. REDUCE Trial (2013) – 5 days of corticosteroids noninferior to 14 days for rehospitalization
2. AECOPD Trial (2011) – Systemic corticosteroids shortened time to recovery and NIV failure

Please carefully review these two studies and take notes on the key details noted above. Your notes will be useful when answering questions on an upcoming quiz about these trials.