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of Bias Appendix F. Results From Included Studies Appendix G. Results by Severity Appendix H. Adverse Events Appendix I. Inclusion and Exclusion Criteria of Included Studies Appendix J. Sensitivity Analysis Appendix K. Appendix References ES-1 Evidence Summary Background and Objectives Chronicobstructivepulmonarydisease (COPD) is a common respiratorydisease characterized by airflowlimitation and chronicrespiratory symptoms. The global prevalence is estimated to be greater than 10 percent (...) of experiencing exacerbations of COPD (ECOPD). There have been various definitions of what constitutes an ECOPD. The Global Initiative for chronicobstructivelungdisease (GOLD) defines ECOPD in its 2019 report as “acute worsening of respiratory symptoms that result in additional therapy.” 5 ECOPD is generally characterized by increased dyspnea, increased frequency and severity of cough, and/or increased sputum production. 6 ECOPD is a leading independent cause of increased mortality and morbidity among
studies, prospective studies, retrospective studies • Acute exacerbations • COPD, chronicobstructivelungdisease, emphysema, chronic bronchitis, lungdiseases (obstructive) • Chronicdisease management, prevention • Nonpharmacologic therapies, education • Self-management • Case management • Action plans • In-home monitoring • Tele-intervention, telehealth, tele-health, Ehealth, e-health, telehealthcare, telecare, telemedicine, tele-monitoring, Emedicine, telecommunications and medicine, teleconsult (...) of acute exacerbations of COPD together with improved health- related quality of life, reduced dyspnea, less rescue medication use, and improved lung function and a relatively lower value on the risks and consequences of oral candidiasis, upper respiratory tract infections, and pneumonia. 22. For patients with stable moderate to very severe COPD, we recommend maintenance combination inhaled corticosteroid/long-acting b 2 -agonist therapy compared with inhaled corticosteroid monotherapy to prevent acute
on the management of #COPDexacerbations from @ERStalk and @atscommunity Executive summary Chronicobstructivepulmonarydisease (COPD) exacerbations are episodes of increased respiratory symptoms, particularly dyspnoea, cough and sputum. The European Respiratory Society (ERS) and American Thoracic Society (ATS) collaborated to develop guidelines that address questions regarding the treatment of COPDexacerbations that are not clearly answered by current guidelines. Key recommendations from the guidelines (...) recommendation, very low quality of evidence). Introduction The chronic and progressive course of chronicobstructivepulmonarydisease (COPD) is often punctuated by “exacerbations”, defined clinically as episodes of increasing respiratory symptoms, particularly dyspnoea, cough and sputum production, and increased sputum purulence. COPDexacerbations have a negative impact on the quality of life of patients with COPD [ , ], accelerate disease progression, and can result in hospital admissions and death
of moderate aggravation in patients with chronicobstructivepulmonarydisease (COPD), it is preferable to prescribe antibiotics as a first-line treatment only when the suspicion of bacterial infection is reinforced by an increase in sputum purulence. Patients with chronicobstructivepulmonarydisease (COPD) are subject to exacerbations of their disease, i.e. episodes of prolonged aggravation. The known causes are mainly viral and bacterial infections. Some exacerbations justify hospitalisation: severe (...) COPD, rapid increase in respiratory signs, presence of associated diseases (e.g. diabetes, cardiovascular diseases). When exacerbation is moderate, the results of available trials show that seven out of ten patients recover in less than four weeks without antibiotics. About one in ten patients heals faster with antibiotic therapy, which may also extend the interval until the next exacerbation. Antibiotic therapies expose patients to the carrying of resistant bacteria, which are sources of harder
, and Schering-Plough. He holds Fiduciary Positions with the American College of Chest Physicians, the Chest Foundation, and the Lung Health Institute of Canada. RAM - no disclosure JO – no disclosure JDR – no disclosure MKS - no disclosure INTRODUCTION Chronicobstructivepulmonarydisease (COPD) is a common disease with substantial associated morbidity and mortality. Patients with COPD usually have a progression of airflowobstruction that is not fully reversible and can lead to a history of progressive (...) efforts to make this guideline a current and valuable addition to the management of the COPD patient. REFERENCES 1 Global strategy for the diagnosis, management n prevention of chronicobstructivepulmonarydisease. Updated 2103.http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Fe b20.pdf. 2 Brusasco V. Reducing cholinergic constriction: the major reversible mechanism in COPD. European Respiratory Review 2006; 15:32-36 3 Cooper CB. Airflowobstruction and exercise. Respir Med 2009; 103:325
exacerbations : a European Respiratory Society/American Thoracic Society guideline Jadwiga A. Wedzicha (ERS co-chair) , Marc Miravitlles , John R. Hurst , Peter M.A (...) of chronicobstructivepulmonarydisease ( COPD ) exacerbations . Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach (...) Week 08, Ovid 2011 12. Management of COPDexacerbations : a European Respiratory Society/American Thoracic Society guideline. This document provides clinical recommendations for treatment of chronicobstructivepulmonarydisease ( COPD ) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development
, actual cost savings largely depend on the expansion of current PR capacity in Ontario. Pulmonary Rehabilitation for Postacute Exacerbations of ChronicObstructivePulmonaryDisease (COPD): A Cost-Effectiveness and Budget Impact Analysis. February 2015; pp. 1-47 6 PLAIN LANGUAGE SUMMARY Chronicobstructivepulmonarydisease (COPD) is a lungdisease that causes worsening breathlessness. The symptoms fluctuate from stable to flare-ups that might need hospital care. Pulmonary rehabilitation (PR) is a key (...) ratio LHIN Local Health Integration Network OHTAC Ontario Health Technology Advisory Committee PATH Programs for Assessment of Technology in Health PR Pulmonary rehabilitation PSA Probabilistic sensitivity analysis RCT Randomized controlled trial RT Respiratory therapist SGRQ St. George’s Respiratory Questionnaire THETA Toronto Health Economics and Technology Assessment Collaborative Pulmonary Rehabilitation for Postacute Exacerbations of ChronicObstructivePulmonaryDisease (COPD): A Cost
is not well documented, COPD is underdiagnosed, and the rate of hospitaliza- tion due to COPD is increasing. 11 Exacerbations are to COPD what myocardial infarctions are to coronary artery disease: Th ey are acute, trajectory- changing, and oft en deadly manifestations of a chronicdisease. Exacerbations cause frequent hospital admis- sions, relapses, and readmissions 12 ; contribute to death during hospitalization or shortly thereaft er 12 ; r e d uce quality of life dramatically 12 , 13 ; consume fi (...) - erbations of COPD together with improved health-related quality of life, reduced dyspnea, less rescue medication use, and improved lung function and a relatively lower value on the risks and consequences of oral candidiasis, upper respiratory tract infections, and pneumonia. 22. For patients with stable moderate to very severe COPD, we recommend maintenance combination inhaled corticosteroid/long-acting b 2 -agonist therapy compared with inhaled corticosteroid monotherapy to prevent acute exacerbations
Does Telehealth Monitoring Identify Exacerbations of ChronicObstructivePulmonaryDisease and Reduce Hospitalisations? An Analysis of System Data The increasing prevalence and associated cost of treating chronicobstructivepulmonarydisease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured (...) during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD.The aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission.A total of 23 participants received a telehealth-supported intervention
COPD, chronicobstructivepulmonarydisease; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; ICU, intensive care unit; ITU, intensive treatment unit. Clinical Bottom Line In line with NICE guidelines, oral steroids should be given to patients with acute exacerbations of COPD in the absence of any contraindications. Level of Evidence Level 1 - Recent well-done systematic review was considered or a study of high quality is available. References de Jong YP, Uil SM, Grotjohan (...) MEDLINE 1948 to Feb Week 4 2011 with the following search strategy ((COPD OR coad).af OR (‘chronicobstructive’ adj3 disease).af) AND (steroid.af) AND (intravenous.af OR oral.af) AND ((acute OR emergen$ OR urgen$ OR decompensat$ OR sudden).af) Search Outcome One-hundred and seventy-four papers were found, of which two were considered relevant to the three-part question. Relevant Paper(s) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses de Jong
CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions The role of antibiotics in acute exacerbations of chronicobstructivepulmonarydisease (COPD) is controversial and a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global (...) Initiative for ChronicObstructiveLungDisease (GOLD) strategy, in order to show a reduction in antibiotic prescription.Patients hospitalised with acute exacerbations of COPD were randomised to receive antibiotics based either on the GOLD strategy or according to the CRP strategy (CRP ≥50 mg·L-1).In total, 101 patients were randomised to the CRP group and 119 to the GOLD group. Fewer patients in the CRP group were treated with antibiotics compared to the GOLD group (31.7% versus 46.2%, p=0.028; adjusted
studies show that patients with low blood oxygen levels who use HFNC oxygen have lower rates of needing mechanical ventilation. Condition or disease Intervention/treatment Phase ChronicObstructivePulmonaryDisease Device: Nasal high flow Not Applicable Detailed Description: Patients admitted to the hospital with an exacerbation of COPD accompanied by respiratory failure need supplemental oxygen and alleviation of an increased work of breathing. Patients with acute exacerbations of COPD have (...) Effects of Nasal High-flow Oxygen in Patients With an Exacerbation of ChronicObstructivePulmonaryDisease (COPD) Effects of Nasal High-flow Oxygen in Patients With an Exacerbation of ChronicObstructivePulmonaryDisease (COPD) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number
Participant Data (IPD) Sharing Statement: Plan to Share IPD: No Layout table for additional information Studies a U.S. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Keywords provided by Hesham Raafat, Ain Shams University: COPD acute exacerbation OPEP Additional relevant MeSH terms: Layout table for MeSH terms LungDiseasesPulmonaryDisease, ChronicObstructiveChronicDiseaseRespiratory Tract DiseasesLungDiseases, ObstructiveDisease Attributes Pathologic Processes (...) hospital stay. oscillating positive expiratory pressure (OPEP) devices were extensively studied in cystic fibrosis and bronchiectasis. Only seldom studied in chronic bronchitis. This study aims to measure the effects of mucous clearing device in hospitalized patients with acute exacerbation of COPD. Condition or disease Intervention/treatment Phase PulmonaryDisease, ChronicObstructive Device: OPEP Aerobika Device: OPEP Aerobika Sham device Not Applicable Detailed Description: In this study
in acute exacerbations of asthma and COPD. Therapeutic Advances in RespiratoryDisease 2009; 3(2): 81-91 PubMedID DOI Original Paper URL Indexing Status Subject indexing assigned by NLM MeSH Adrenergic beta-Agonists /administration & Albuterol /administration & Asthma /drug therapy /physiopathology; Bronchodilator Agents /administration & Disease Progression; Ethanolamines /administration & Formoterol Fumarate; Humans; Nebulizers and Vaporizers; PulmonaryDisease, ChronicObstructive /drug therapy (...) Use of dry powder inhalers in acute exacerbations of asthma and COPD Use of dry powder inhalers in acute exacerbations of asthma and COPD Use of dry powder inhalers in acute exacerbations of asthma and COPD Selroos O, Borgstrom L, Ingelf J CRD summary This review concluded that dry powder inhalers functioned equally as well as established therapies with other inhaler devices in patients with acute asthma or chronicobstructivepulmonarydisease. Given poor reporting of the review process
or S2 or S3 or S5 Search modes - Boolean/Phrase 9484 Inhospital Physiotherapy for AECOPD: A Rapid Review. January 2013; pp. 1–28. 23 S5 chronic bronchitis or emphysema Search modes - Boolean/Phrase 1880 S4 (MH "Emphysema+") Search modes - Boolean/Phrase 1189 S3 copd or coad Search modes - Boolean/Phrase 5022 S2 (chronicobstructive and (lung* or pulmonary or airway* or airflow or respiratory) and (disease* or disorder*)) Search modes - Boolean/Phrase 7495 S1 (MH "PulmonaryDisease, Chronic (...) Inhospital Physiotherapy for AECOPD: A Rapid Review. January 2013; pp. 1–28. 20 Cochrane Library ID Search Hits #1 MeSH descriptor: [PulmonaryDisease, ChronicObstructive] explode all trees 1838 #2 chronic near/2 obstructive near/2 (lung* or pulmonary or airway* or airflow or respiratory) next (disease* or disorder*):ti,ab,kw OR copd or coad:ti,ab,kw OR chronicairflow obstruction:ti,ab,kw 7234 #3 MeSH descriptor: [Emphysema] explode all trees 92 #4 (chronic near/2 bronchitis) or emphysema:ti,ab,kw 1932
) and/or diarrhoea, including Clostridium difficile -associated diarrhoea (associated with the use of antibiotics). Definition Chronicobstructivepulmonarydisease (COPD) is "a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflowlimitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases." Global Initiative for ChronicObstructiveLungDisease. Global strategy for the diagnosis (...) , management and prevention of chronicobstructivepulmonarydisease. November 2017 [internet publication] http://goldcopd.org/gold-reports/ An exacerbation of COPD may be defined as "an acute worsening of respiratory symptoms that results in additional therapy." Global Initiative for ChronicObstructiveLungDisease. Global strategy for the diagnosis, management and prevention of chronicobstructivepulmonarydisease. November 2017 [internet publication] http://goldcopd.org/gold-reports/ History and exam