Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) face limited treatment options and inadequate access to palliative care. Aim: To provide a pragmatic overview of clinical guidelines and produce evidence-based recommendations for severe COPD. Interventions for which there is inconsistent evidence to support their use and areas requiring further research were identified. Design: Practice review of guidelines supported by scoping review methodology to examine the evidence reporting the use of guideline-recommended interventions. Data sources: An electronic search was undertaken in MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Database of Systematic Reviews, complemented by web searching for guidelines and publications providing primary evidence (July 2021). Guidelines published within the last 5 years and evidence in the last 10 years were included. Results: Severe COPD should be managed using a multidisciplinary approach with a holistic assessment. For stable patients, long-acting beta-agonist/long-acting muscarinic antagonist and pulmonary rehabilitation are recommended. Low dose opioids, self-management, handheld fan and nutritional support may provide small benefits, whereas routine corticosteroids should be avoided. For COPD exacerbations, systematic corticosteroids, non-invasive ventilation and exacerbation action plans are recommended. Short-acting inhaled beta-agonists and antibiotics may be considered but pulmonary rehabilitation should be avoided during hospitalisation. Long term oxygen therapy is only recommended for patients with chronic severe hypoxaemia. Short-acting anticholinergic inhalers, nebulised opioids, oral theophylline or telehealth are not recommended. Conclusions: Recommended interventions by guidelines are not always supported by high-quality evidence. Further research is required on efficacy and safety of inhaled corticosteroids, antidepressants, benzodiazepines, mucolytics, relaxation and breathing exercises.

[Retracted] The Efficacy and Safety of Budesonide/Glycopyrronium/Formoterol in the Treatment of COPD in the Elderly

“…With the development of the social economy, air pollution has become a serious public health problem all over the world, which seriously endangers the health of residents and leads to a heavy burden of disease [ 9 ]. Atmospheric particulate matter is an important part of air pollutants.…”

“…Atmospheric particulate matter is an important part of air pollutants. In recent years, its relationship with an acute attack and death of respiratory diseases has been explained [ 9 ].…”

Association of Community-Acquired Pneumonia (Cap) With Inhaled Corticosteroids (Ics) Among Patients With Chronic Obstructive Pulmonary Disease

“…It is proved in multiple clinical trials, that a fixed-dose combination of an ICS and long-acting β2agonist (LABA) used in the treatment of COPD, not only decreases the frequency of COPD exacerbations 10 by about 25% but also slows down disease progression 11 and prognosis of disease also improves. 12 Use of this combined therapy not only has better bronchodilator properties but is even better at preventing exacerbation when compared to bronchodilator therapy alone. 13. Variations in results in terms of exacerbation frequency and prognosis have been noted with various ICSs.…”

Chronic obstructive pulmonary disease and respiratory failure

“…In some patients, ICS/LABA or ICS therapy may be the first choice; this treatment has the highest probability of reducing exacerbations when the EOS count is ≥300 cells/μL (Figures 1 and 2). 11 However, among older comorbid patients, it is necessary to have more vigilant monitoring for adverse effects of these agents than what is indicated in the guidelines. While a pooled analysis of several trials reported increased risks for cardiovascular events and mortality with the use of inhaled anticholinergics, a large randomized controlled trial that did not demonstrate this association excluded patients with previous myocardial infarction, heart failure, or preexisting arrhythmias.…”