Chronic Obstructive Pulmonary Disease (COPD) - Related Resources

Drug therapy

• Tiotropium treatment for COPD is associated with fewer exacerbations compared with ipratropium bromide. It also appears to be associated with improved lung function, fewer hospital admissions, and improved quality of life Tiotropium Versus Ipratropium for COPD.
• Inhaled short-acting beta2-agonists are effective in most but not all patients with moderate to severe COPD Short-Acting Beta2-Agonists for Chronic Obstructive Pulmonary Disease.
• Anti-cholinergic bronchodilatators appear to have similar efficacy as beta-2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease Anti-Cholinergic Bronchodilators Versus Beta2-Sympathomimetic Agents for Acute Exacerbations of Chronic Obstructive Pulmonary Disease.
• Both long-acting beta-agonist and inhaled corticosteroid therapy confer similar benefits across the majority of outcomes in patients with stable chronic obstructive pulmonary disease Inhaled Corticosteroids Versus Long-Acting Beta(2)-Agonists for Chronic Obstructive Pulmonary Disease.
• Combination of a corticosteroid and a long-acting beta-agonist in one inhaler is effective in reducing acute exacerbations in adults with chronic obstructive pulmonary disease when compared to placebo, to mono-component steroid or to mono-component long-acting beta-agonists. As compared to placebo or mono-component steroid, the combination also reduces mortality. Pneumonia is more common with combined inhalers as compared to options not including steroidsCombined Corticosteroid and Long-Acting Beta-Agonist in One Inhaler for Chronic Obstructive Pulmonary Disease.
• The addition of inhaled corticosteroid (ICS) and long-acting beta2-agonist (LABA) combination treatment to tiotropium may improve health-related quality of life and lung function in chronic obstructive pulmonary disease. If the combination tiotropium + LABA is already in use, the addition of ICS may not bring additional benefit. There is uncertainty regarding the effects on mortality, hospitalisation, exacerbations of COPD and pneumonia. Tiotropium, Inhaled Steroids and Long-Acting Beta2-Agonists Alone or in Combinations for Chronic Obstructive Pulmonary Disease
• Cardioselective beta-blockers do not produce significant short-term reduction in airway function when given to patients with COPD Cardioselective Beta-Blockers for Chronic Obstructive Pulmonary Disease.
• Oral steroids appear to improve lung function and symptoms more than placebo in stable chronic obstructive pulmonary disease, but not all people benefit equally. Long-term use does not slow the decline in lung function and there is an increased risk of side-effects Oral Corticosteroids for Stable COPD.
• Use of continuous prophylactic antibiotics are effective in reducing exacerbations in patients with at least moderately severe COPDProphylactic Antibiotic Therapy for Chronic Obstructive Pulmonary Disease.
• PDE4 inhibitors (roflumilast, cilomilast) appear to improve lung function and reduce likelihood of exacerbations in people with stable COPD regardless of the severity of the disease Phosphodiesterase 4 Inhibitors for Chronic Obstructive Pulmonary Disease.

Surgery

• Stapling is more effective than laser resection for lung volume reduction in diffuse emphysema, but there is no evidence from randomized trials comparing surgery with optimal conservative treatment Lung Volume Reduction Surgery (LVRS) in Diffuse Emphysema.

Physiotherapy and rehabilitation

• Water-based exercise training compared with no exercise training improves exercise capacity and may improve health-related quality of life in COPD. Water-based exercise training appears to improve endurance exercise capacity compared with land-based exercise training Water-Based Exercise Training for Chronic Obstructive Pulmonary Disease.
• Breathing exercises appear to improve functional exercise capacity in patients with severe COPD Breathing Exercises for Chronic Obstructive Pulmonary Disease.
• There is little evidence on the effectiveness of ambulatory domiciliary oxygen therapy on exercise capacity in patients with COPD Ambulatory Oxygen for Improving Exercise Capacity in Patients with COPD.
• Nocturnal positive pressureventilation appears not to improve the condition of patients with COPD Nocturnal Positive Pressure Ventilation for COPD.
• Patients with COPD may exercise longer and have less shortness of breath when using oxygen during an exercise-training program Oxygen Therapy during Exercise Training in Chronic Obstructive Pulmonary Disease.
• Pulmonary rehabilitation including exercise therapy after a recent exacerbation appears to reduce hospital admissions and mortality Pulmonary Rehabilitation Following Exacerbations of Chronic Obstructive Pulmonary Disease.

Lifestyle and counselling

• Nutritional support has no significant effect on anthropometric measures, lung function or exercise capacity in patients with stable COPD Nutritional Supplementation in Stable Chronic Obstructive Pulmonary Disease.
• Self-management interventions appear to be associated with a reduction in respiratory-related hospital admissions, improved health-related quality of life, and improvement in dyspnoea in patients with chronic obstructive pulmonary disease (COPD) Self-Management for Patients with Chronic Obstructive Pulmonary Disease.

Prevention and screening

• Vaccinating patients who have recurrent acute exacerbations of chronic bronchitis with oral H. influenzae vaccine in the autumn may reduce the number and severity of exacerbations over the following winter Haemophilus Influenzae Vaccination for the Prevention of Acute Exacerbations of Chronic Bronchitis.

Others

• Treatment of acute exacerbations of COPD in hospital at home with support from respiratory nurses appears to lead to fewer readmissions in comparison with conventional hospital treatmentHospital at Home for Acute Exacerbations of Chronic Obstructive Pulmonary Disease.
• Action plans may aid people with COPD in recognising and reacting appropriately to an exacerbation of their symptoms via the self-initiation of antibiotics or steroids, but these changes appear not to translate into a reduction in healthcare utilisation or improvement in patient well being Action Plans for Chronic Obstructive Pulmonary Disease.
• Outreach nursing programmes for COPD may improve health-related quality of life but may not affect mortality or the number of hospitalisations Home Care by Outreach Nursing for Chronic Obstructive Pulmonary Disease.
• Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital Telehealthcare for Chronic Obstructive Pulmonary Disease.

Clinical practice reviews

Other literature

• Loke YK, Cavallazzi R, Singh S. Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomised controlled trials and observational studies. Thorax 2011;66(8):699-708. [PubMed]
• McCrory DC, Brown C, Gelfand SE, Bach PB. Management of acute exacerbations of COPD: a summary and appraisal of published evidence. Chest 2001 Apr;119(4):1190-209. [PubMed]
• Wijkstra PJ, Lacasse Y, Guyatt GH, Casanova C, Gay PC, Meecham Jones J, Goldstein RS. A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD. Chest 2003 Jul;124(1):337-43. [PubMed]
• Celli BR, MacNee W, ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004 Jun;23(6):932-46. [PubMed]
• Snow V, Lascher S, Mottur-Pilson C, Joint Expert Panel on Chronic Obstructive Pulmonary Disease of the American College of Chest Physicians and the American College of Physicians-American Society of Internal Medicine. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 2001 Apr 3;134(7):595-9. [PubMed]
• Bach PB, Brown C, Gelfand SE, McCrory DC, American College of Physicians-American Society of Internal Medicine, American College of Chest Physicians. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern Med 2001 Apr 3;134(7):600-20. [PubMed]
• Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001 Apr;163(5):1256-76. [PubMed]