ATS issues clinical practice guideline for pharmacologic management of COPD

  • Nici L & al.
  • Am J Respir Crit Care Med
  • 13 Apr 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • The American Thoracic Society (ATS) issued a clinical practice guideline for pharmacologic management of COPD.

Why this matters

  • The guideline is designed to improve QoL and control symptoms while reducing the frequency of exacerbations.

Study design

  • Expert review based on collaborative effort of COPD clinicians and researchers along with a team of methodologists.
  • Recommendations addressing 4 major questions were formulated using GRADE.
  • Funding: ATS.

Key recommendations

  • For patients with COPD complaining of dyspnea or exercise intolerance:
    • Use combination treatment with a long-acting β2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) rather than monotherapy with LABA or LAMA.
    • If these symptoms persist despite combination therapy, add inhaled corticosteroids to combination therapy (therefore triple therapy) in those with ≥1 exacerbation in the prior year requiring antibiotics or oral steroids or hospitalization.
  • Drop the inhaled corticosteroid if no exacerbations occur in the past year.
  • Do not use maintenance oral corticosteroid therapy in patients with frequent and severe exacerbations while on optimal therapy.
  • Consider opioid-based therapy in patients with advanced refractory dyspnea despite otherwise optimal therapy.

Limitations

  • All but 1 recommendation (the first) were considered conditional rather than strong.