In the ‘80s, although the Anthonisen criteria were based on patients’ symptoms reporting an AECOPD (increase of dyspnea, sputum purulence and sputum volume), the presence of a change in sputum characteristics, with increased cough and wheeze, could identify an AECOPD needing a specific antibiotic approach. The possibility to define in the same ways the AECOPD could have implications on decision-making, changing therapeutic interventions in clinical trials. The absence of homogeneity in the definition of an AECOPD has opened controversial opinions in the last few years. There are currently few promising new drugs or new applications of existing drugs. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients.
HFNC oxygen therapy needs further prospective studies. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. Several treatments exist for severe AECOPD patients requiring hospitalization. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments.
LAMA LABA AAFP UPDATE
In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy this event is defined as a COPD exacerbation (AECOPD).
0 kommentar(er)
