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Evidence-Based Medicine

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Researchers examine available evidence on managing acute episodes of chronic obstructive pulmonary disease

More than 16 million adults in the United States suffer from chronic obstructive pulmonary disease (COPD)—that is, their airflow is obstructed due to chronic bronchitis, emphysema, or asthma. COPD is responsible for enormous disability and $18 billion each year in direct health care costs. It results from smoking (85 to 90 percent of all cases), genetic factors, passive smoke, occupational exposure, air pollution, and possibly over-responsive airways.

A recently published study summarizes the available evidence on managing acute exacerbations of COPD, which are typically caused by tracheobronchial infections, air pollution, and serious clinical conditions, such as heart failure and nonpulmonary infection. The study was conducted by researchers at Memorial Sloan Kettering Cancer Center and the Evidence-based Practice Center at Duke University, which is supported in part by the Agency for Healthcare Research and Quality (contract 290-97-0014).

The researchers reviewed the scientific literature from 1966 to 2000 on managing acute exacerbations of COPD and found limited data on the usefulness of most diagnostic tests. However, based on these limited data, they note that chest x-rays and arterial blood gas sampling seem useful for diagnosing acute exacerbations of COPD, while acute spirometry (measuring breathing capacity of the lungs) does not.

Evidence was found for the efficacy of bronchodilators, corticosteroids, and noninvasive positive-pressure ventilation, as well as the use of antibiotics in patients with more severe exacerbations. On the other hand, based on limited data, mucolytics and chest physiotherapy do not seem to be beneficial. Oxygen supplementation seems to increase the risk of respiratory failure only in an identifiable subgroup of patients. Despite the suggestions for appropriate management of COPD drawn from these studies, the supporting evidence is scarce, and further high-quality research is needed before treatment recommendations can be made, conclude the researchers.

See "Management of acute exacerbations of chronic obstructive pulmonary disease: A summary and appraisal of published evidence," by Peter B. Bach, M.D., M.A.P.P., Cynthia Brown, M.D., Sarah E. Gelfand, B.A., and Douglas C. McCrory, M.D., M.H.Sc., in the April 3, 2001 Annals of Internal Medicine 134(7), pp. 600-620.

Editor's Note: Print copies of the evidence report from which this article was drawn, Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease, Evidence Report/Technology Assessment No. 19 (AHRQ Publication No. 01-E002) are available from the AHRQ Publications Clearinghouse. Select to access the summary of this report online.

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