@article{d86b41a5d5ee452fbf796c2ab144ffe5,
title = "Pharmacologic Management of Chronic Obstructive Pulmonary Disease An Official American Thoracic Society Clinical Practice Guideline",
abstract = "Background: This document provides clinical recommendations for the pharmacologic treatment of chronic obstructive pulmonary disease (COPD). It represents a collaborative effort on the part of a panel of expert COPD clinicians and researchers along with a team of methodologists under the guidance of the American Thoracic Society. Methods: Comprehensive evidence syntheses were performed on all relevant studies that addressed the clinical questions and critical patient-centered outcomes agreed upon by the panel of experts. The evidence was appraised, rated, and graded, and recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: After weighing the quality of evidence and balancing the desirable and undesirable effects, the guideline panel made the following recommendations: 1) a strong recommendation for the use of long-acting b2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy over LABA or LAMA monotherapy in patients with COPD and dyspnea or exercise intolerance; 2) a conditional recommendation for the use of triple therapy with inhaled corticosteroids (ICS)/LABA/LAMA over dual therapy with LABA/LAMA in patients with COPD and dyspnea or exercise intolerance who have experienced one or more exacerbations in the past year; 3) a conditional recommendation for ICS withdrawal for patients with COPD receiving triple therapy (ICS/LABA/LAMA) if the patient has had no exacerbations in the past year; 4) no recommendation for or against ICS as an additive therapy to long-acting bronchodilators in patients with COPD and blood eosinophilia, except for those patients with a history of one or more exacerbations in the past year requiring antibiotics or oral steroids or hospitalization, for whom ICS is conditionally recommended as an additive therapy; 5) a conditional recommendation against the use of maintenance oral corticosteroids in patients with COPD and a history of severe and frequent exacerbations; and 6) a conditional recommendation for opioid-based therapy in patients with COPD who experience advanced refractory dyspnea despite otherwise optimal therapy. Conclusions: The task force made recommendations regarding the pharmacologic treatment of COPD based on currently available evidence. Additional research in populations that are underrepresented in clinical trials is needed, including studies in patients with COPD 80 years of age and older, those with multiple chronic health conditions, and those with a codiagnosis of COPD and asthma.",
keywords = "COPD, Dyspnea, Exacerbation, Pharmacotherapy, Steroids",
author = "Linda Nici and Aaron, {Shawn D.} and Alexander, {Paul E.} and Au, {David H.} and Boyd, {Cynthia M.} and Edward Charbek and Criner, {Gerard J.} and Donaldson, {Gavin C.} and Michael Dreher and Fan, {Vincent S.} and Gershon, {Andrea S.} and Han, {Meilan K.} and Krishnan, {Jerry A.} and Mammen, {Manoj J.} and Martinez, {Fernando J.} and Meek, {Paula M.} and Michael Morgan and Polkey, {Michael I.} and Puhan, {Milo A.} and Mohsen Sadatsafavi and Sin, {Don D.} and Washko, {George R.} and Wedzicha, {Jadwiga A.}",
note = "Funding Information: 1Providence Veterans Affairs Medical Center, Providence, Rhode Island; 2The Warren Alpert Medical School of Brown University, Providence, Rhode Island; 3The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; 4McMaster University, Hamilton, Ontario, Canada; 5Veterans Affairs Puget Sound Health Care System, Seattle, Washington; 6University of Washington, Seattle, Washington; 7Johns Hopkins University School of Medicine, Baltimore, Maryland; 8Saint Louis University, St. Louis, Missouri; 9Lewis Katz School of Medicine, Philadelphia, Pennsylvania; 10National Heart and Lung Institute, Imperial College, London, United Kingdom; 11University Hospital Aachen, Rheinisch-Westf{\"a}lische Technische Hochschule Aachen University, Aachen, Germany; 12Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; 13University of Michigan, Ann Arbor, Michigan; 14University of Illinois, Chicago, Illinois; 15Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; 16Cornell University Medical Center, New York, New York; 17College of Nursing, University of Colorado Anschutz Medical Campus, Denver, Colorado; 18University Hospitals of Leicester National Health Service Trust, University of Leicester, Leicester, United Kingdom; 19Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom; 20Department of Epidemiology, University of Zurich, Zurich, Switzerland; 21The University of British Columbia, Vancouver, British Columbia, Canada; and 22Brigham and Women{\textquoteright}s Hospital, Boston, Massachusetts Author Disclosures: D.H.A. served as a consultant for Gilead; and on a data and safety monitoring board for Novartis. C.M.B. received author royalties from UpToDate. E.C. served on an advisory committee for Mylan/Theravance. G.J.C. served as a consultant for Amirall, Bayer, Chiesi, Celerion, Holaira, Mereo, Novartis, Nuvaira, PneumRx, Pulmonetics, Pulmonx, ResMed, and Respironics; received research support from Actelion, Aeris, AstraZeneca, Boehringer Ingelheim, Chiesi, Celerion, Forest, GlaxoSmithKline, Ikaria, MedImmune, Mereo, Novartis, Pearl, PneumRx, Pulmonx, ResMed, Respironics, and Spiration; served on an advisory committee for AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline; and has ownership or investment interests in HGE Health Care Solutions. G.C.D. served as a consultant and received research support from AstraZeneca. M.D. served as a consultant for Almirall, Boehringer Ingelheim, Hamilton, Linde, Novartis, Pfizer, Philips Respironics, ResMed, and Roche; served as a speaker for Actelion, AstraZeneca, Bayer, Boehringer Ingelheim, Chiesi, Hamilton, Heinen und L{\"o}wenstein, InterMune, Linde, Novartis, Pfizer, Philips Respironics, ResMed, and Roche; received research support from Philips Respironics and ResMed; and received personal fees from Berlin Chemie and GlaxoSmithKline. M.K.H. served as a consultant for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck, and Mylan; served on a data and safety monitoring board for Novartis; served as a speaker for Novartis; and received research support from Novartis and Sunovion. J.A.K. served on a data safety and monitoring board for Sanofi; served as a speaker for Philips; and received research support from Inogen, PCORI, and ResMed. M.J.M. received research support from GlaxoSmithKline and Sanofi. F.J.M. served on an advisory committee for AstraZeneca, Boehringer Ingelheim, CSL Behring, Gala, Genentech, GlaxoSmithKline, Merck, Novartis, Pearl, Veracyte, and Zambon; served as a consultant for AstraZeneca, Boehringer Ingelheim, Bridge Biotherapeutics, Bristol Myers Squibb, Chiesi, Genentech, GlaxoSmithKline, Patara/Respivent, ProTerrixBio, Sunovion, Teva, and TwoXR; served on a data safety and monitoring board for Biogen, Boehringer Ingelheim, Genentech, and GlaxoSmithKline; served as a speaker for Boehringer Ingelheim, CME Outfitters, France Foundation, MD Magazine, Miller Communications, National Association for Continuing Education, Novartis, PeerView, Physicians Education Resource, Prime Education, Rare Diseases Healthcare Communications, Rockpointe, Vindico, and WebMD/MedScape; received research support from AstraZeneca, Bayer, Biogen, Boehringer Ingelheim, Gilead, GlaxoSmithKline, Nitto, Patara/Respivent, Promedior, ProMetic, ProTerrixBio, Veracyte, Verona, and Zambon; and received author royalties from UpToDate. M.I.P. served as a consultant for GlaxoSmithKline and Philips Respironics; and received research support from GlaxoSmithKline. M.S. served as a speaker for AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline; and received research support from AstraZeneca and GlaxoSmithKline. D.D.S. served as a speaker for Boehringer Ingelheim; and received research support from AstraZeneca and IKOMED. G.R.W. served on an advisory committee for Boehringer Ingelheim, CSL Behring, GlaxoSmithKline, and Vertex; served as a consultant for Boehringer Ingelheim, CSL Behring, Janssen, Novartis, PulmonX, and Vertex; served on a data and safety monitory board for PulmonX; received research support from Boehringer Ingelheim, BTG, and Janssen; has ownership and investment interest in Quantitative Image Solutions; and his spouse is an employee of Biogen. J.A.W. served as a speaker for Medscape; served on a data and safety monitoring board for Virtus Respiratory Research; received research support from AstraZeneca, Boehringer Ingelheim, Chiesi, Genentech, GlaxoSmithKline, Johnson & Johnson, and Novartis; and received travel support from AstraZeneca, Boehringer Ingelheim, Cipla, and Novartis. L.N., S.D.A., P.E.A., V.S.F., A.S.G., P.M.M., M.M., and M.A.P. reported no relevant commercial relationships. Publisher Copyright: Copyright {\textcopyright} 2020 by the American Thoracic Society.",
year = "2020",
month = may,
day = "1",
doi = "10.1164/RCCM.202003-0625ST",
language = "English (US)",
volume = "201",
pages = "E56--E69",
journal = "American Review of Respiratory Disease",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "9",
}