Chest
SPECIAL FEATURESContemporary Management of Acute Exacerbations of COPD: A Systematic Review and Metaanalysis
Section snippets
Methods and Materials
We decided a priori to examine the published evidence for systemic corticosteroids, antibiotics, and NPPV in the treatment of acute COPD exacerbations. For each of these therapies, we conducted a literature search by using MEDLINE and EMBASE. We limited the search to English-language articles published from January 1968 to November 2006, conducted in adults (> 19 years of age) using a randomized, controlled trial design. To limit the studies to COPD, we used the following terms: chronic
Systemic Corticosteroids
A total of 10 studies10111213141516171819 involving 959 patients (Table 2) were identified that examined the effects of systemic corticosteroids during acute COPD exacerbations. The mean age of patients of these studies was 67 years. The patients at the time of presentation to the hospital demonstrated an average arterial pH of 7.40 and Paco2 of 42 mm Hg. Most of the patients were active smokers with a mean smoking history of 63 pack-years. The treatment was initiated in hospital in eight of
Discussion
Acute exacerbations of COPD are an increasing cause of morbidity, mortality, and economic burden in the United States and elsewhere. Despite the widespread promulgation of clinical guidelines by various expert committees and professional societies over the past decade, there continues to be considerable heterogeneity in the way in which acute exacerbations are managed between physicians.31 For instance, a large survey31 found that < 3% of patients with acute COPD exacerbations were treated with
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Is PM<inf>2.5</inf> associated with emergency department visits for mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease?
2021, American Journal of Emergency MedicineCitation Excerpt :Patients with COPD tend to have recurrent exacerbations and ARF triggered by air pollution [15,22,43-45]. Ventilators are essential equipment for the care of AECOPD patients who experience ARF [16-21,24]; however, ED ventilator demand/capacity mismatch may occur due to a peak in AECOPD development during air pollution and climate change. For the needs of the study, predicting and monitoring ventilator need may help manage AECOPD patients with ARF and the necessary ancillary equipment in advance [1,44,46].
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This project is supported by the Canadian Institutes of Health Research. Dr. Sin is a Canada Research Chair in COPD and a senior scholar with the Michael Smith Foundation for Health Research.
The authors have no conflicts of interest to disclose.