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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 40 mg per day for 5 days is recommended. Therapy with oral prednisolone is equally effective to intravenous administration Prednisolone 30 mg orally should be prescribed for 7 to 14 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 7 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)
  1. Reported from references [1, 9, 10]
  2. Abbreviations: SABA indicates short-acting β2 agonists, MDI metered-dose inhaler, HFNC high flow nasal cannulae oxygen therapy, NIMV non-invasive mechanical ventilation, SaO2 oxygen saturation, ARF acute respiratory failure