chronic obstructive pulmonary disease, exacerbations
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2011 Aug 25;365(8):689-98 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
long-term antibiotics, azithromycin 250 mg daily for 1 year
As Prevention, Secondary
Is better Than
placebo
To reduce (but only marginally) nuber of exacerbations (1.5 par year azytro VS 1.8 per year placebo. Hearing impairment was higher: 25% patients azytro VS 20% placebo
Ann Intern Med. 2001 Apr 3;134(7):600-620 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations The Use of
bronchodilators, corticosteroids, antibiotics, and non-invasive positive-pressure ventilation
As Treatment, Acute
Is better Than
placebo or treatment not using it
To reduce death, need for intubation or reduce lenght of hospital stay.
BMJ. 2011 Jun 14;342:d3215. doi: 10.1136/bmj.d3215 Systematic Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
inhaled anticholinergics, long acting, tiotropium, using mist inhaler
As Treatment, Acute
Is worse Than
placebo
To mortality: increased with tiotropium (2.4%) VS placebo (1.7%). NNH = 124
Thorax. 2001 Sep;56(9):708-712 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
non-invasive ventilation
As Treatment, Acute
Is better Than
standard treatment without ventilatory support
To reduce mortality: median length of survival was 17 months in those treated with ventilation VS 13 months without
Lancet. 2000 Jun 3;355(9219):1931-1935 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
non-invasive ventilation
As Treatment, Acute
Is better Than
standard treatment without ventilatory support
To reduce need for intubation (15% with ventilation VS 27% without) and reduce mortality (10% with ventilation VS 20% without)
Thorax. 2008 May;63(5):415-22 Meta-Analysis
IN chronic obstructive pulmonary disease, exacerbations The Use of
short-course antibiotic treatment (5 days or less)
As Treatment, Acute
Is equal Than
longer duration of antibiotic course
To achieve clinical and bacteriological cure (OR 1.0 and 1.05 respectively)
Chest. 2005 Jul;128(1):48-54 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations The Use of
smaller doses of short-acting inhaled beta2 agonists (albuterol, 2.5mg/4h)
As Treatment, Acute
Is equal Than
greater doses of the same drug (albuterol, 5mg/4h)
To increase FEV1 and peak expiratory flow rate, increase recovery rate, reduce hospital stay (trend to lower stay with higher doses: 6 vs 9 days, but not significant) or reduce side effects.
N Engl J Med. 1999 Jun 24;340(25):1941-7 Randomized Controlled Trial, Multicenter Study
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids
As Treatment, Acute
Is better Than
placebo
To reduce treatment failure (death or mechanical ventilation or need to intensificate treatment): 23% with corticoids VS 33% without. Also, reduce lenght of hospital stay.
Lancet. 1999 Aug 7;354(9177):456-60 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids
As Treatment, Acute
Is better Than
placebo
To improve faster FEV1 and reduce lenght of hospital stay
Cochrane Database Syst Rev. 2005;(1):CD001288 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids
As Treatment, Acute
Is better Than
placebo
To reduce, at 1 month, treatment failure (NNT 9) and improve respiratory failure and breathlessness, but increased adverse effects (OR 2.3)
Chest. 2008 Mar;133(3):756-66 Systematic Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation
As Treatment, Acute
Is better Than
placebo or no use of that treatment
To reduce in-hospital mortality (antibiotics and ventilation) and reduce treatment failure (all, corticosteroids)
BMJ. 2003 Sep 20;327(7416):643 Meta-Analysis
IN chronic obstructive pulmonary disease, exacerbations The Use of
theophylline, methylxanthines
As Treatment, Acute
Is worse Than
placebo
To it did not reduce admissions to hospital, length of stay and relapses at one week. But it caused more adverse effects: vomiting, tremor, arrhythmias
Cochrane Database Syst Rev. 2018 Oct 30;10:CD009764 Systematic Review, Cochrane Review
IN chronic obstructive pulmonary disease, exacerbations The Use of
long-term antibiotics, macrolides, for 3 to 12 months
As Treatment, Chronic
Is better Than
placebo
To reduce patients with exacerbations at 1 year (47% antibiotics VS 61% controls). No effect in hospital admissions, change in FEV1, serious adverse events or all-cause mortality.
Chest. 2007 Jan;131(1):9-19 Randomized Controlled Trial
IN chronic obstructive pulmonary disease, exacerbations, respiratory infection, lower airways The Use of
procalcitonin, treating with antibiotics according to serum procalcitonin levels
As Diagnostic Tool
Is better Than
systematic treatment with antibiotics
To identify patients with active respiratory infection and guide antibiotic use: it reduced antibiotic use (40% vs 72%) obtaining same clinical outcome at 14 days and rehospitalzation rate (21% vs 24%)
Chest. 2001 Jun;119(6):1840-1849 Descriptive
IN chronic obstructive pulmonary disease, exacerbations, severe, requiring invasive mechanical ventilation The Use of
presence of comorbidities, APACHE, need for ventilation for > 72h or extubation failure
As Prognostic Item
Is useful Than
-
To predict higher in-hospital mortality