Table 4 Summary of recommendations or suggestions from the GOLD document, NICE guidelines and ERS/ATS guidelines about management of severe AECOPD
From: Management of severe acute exacerbations of COPD: an updated narrative review
In-hospital AECOPD treatments | GOLD document | NICE guidelines | ERS/ATS guidelines |
|---|---|---|---|
Bronchodilators | SABA with or without short-acting anticholinergics are the initial bronchodilators recommended. It is recommended that patients do not receive continuous nebulization, but use the MDI inhaler. It is recommended continuining long-acting bronchodilators or starting as soon as possible | Increased doses of short-acting bronchodilators are suggested. Both nebulisers and hand-held inhalers can be used to administer inhaled therapy. Patients should be changed to hand-held inhalers as soon as their condition has stabilised | It is not reported |
Steroids | Prednisone 40Â mg per day for 5Â days is recommended. Therapy with oral prednisolone is equally effective to intravenous administration | Prednisolone 30Â mg orally should be prescribed for 7 to 14Â days | Suggested oral administration (conditional recommendation, low quality of evidence) |
Antibiotics | They should be given in patients who have: all three symptoms (increase in dyspnea, sputum volume, and sputum purulence); increased sputum purulence; required mechanical ventilation. The recommended length of therapy is 5 to 7Â days | Antibiotics should be used to treat exacerbations of COPD associated with a history of more purulent sputum | It is not reported for hospitalized patients with AECOPD |
Oxygen therapy | If necessary, oxygen should be given to keep the SaO2 within the individualised target range | Supplemental oxygen should be titrated to improve hypoxemia, with a target SaO2 of 88 to 92% | It is not reported |
HFNC | In patients with hypoxemic ARF it may be an alternative to standard oxygen therapy or NIMV. There is a need for well-designed, randomized, multicenter trials to study the effects of HFNC in hypoxemic/hypercapnic ARF. | It is not reported | It is not reported |
NIMV | It is indicated in patients with respiratory acidosis or severe dyspnoea with clinical signs suggestive of respiratory muscle fatigue, increased work of breathing, or persistent hypoxemia despite supplemental oxygen therapy | It should be used as the treatment of choice for persistent hypercapnic ventilatory failure during exacerbations despite optimal medical therapy | It is recommended for patients with acute or acute-on-chronic hypercapnic respiratory failure (strong recommendation, low quality of evidence) |
Pulmonary rehabilitation | It is not reported for hospitalized patients with AECOPD | It is not reported for hospitalized patients with AECOPD | It is suggested not initiating during hospitalisation (conditional recommendation, very low quality of evidence) |