Dataset Information

Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review.

ABSTRACT:

Background

Patients with chronic obstructive pulmonary disease (COPD) face limited treatment options and inadequate access to palliative care.

Aim

To provide a pragmatic overview of clinical guidelines and produce evidence-based recommendations for severe COPD. Interventions for which there is inconsistent evidence to support their use and areas requiring further research were identified.

Design

Practice review of guidelines supported by scoping review methodology to examine the evidence reporting the use of guideline-recommended interventions.

Data sources

An electronic search was undertaken in MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Database of Systematic Reviews, complemented by web searching for guidelines and publications providing primary evidence (July 2021). Guidelines published within the last 5 years and evidence in the last 10 years were included.

Results

Severe COPD should be managed using a multidisciplinary approach with a holistic assessment. For stable patients, long-acting beta-agonist/long-acting muscarinic antagonist and pulmonary rehabilitation are recommended. Low dose opioids, self-management, handheld fan and nutritional support may provide small benefits, whereas routine corticosteroids should be avoided. For COPD exacerbations, systematic corticosteroids, non-invasive ventilation and exacerbation action plans are recommended. Short-acting inhaled beta-agonists and antibiotics may be considered but pulmonary rehabilitation should be avoided during hospitalisation. Long term oxygen therapy is only recommended for patients with chronic severe hypoxaemia. Short-acting anticholinergic inhalers, nebulised opioids, oral theophylline or telehealth are not recommended.

Conclusions

Recommended interventions by guidelines are not always supported by high-quality evidence. Further research is required on efficacy and safety of inhaled corticosteroids, antidepressants, benzodiazepines, mucolytics, relaxation and breathing exercises.

SUBMITTER: Fu Y

PROVIDER: S-EPMC9087316 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review.

Fu Yu Y Chapman Emma J EJ Boland Alison C AC Bennett Michael I MI

Palliative medicine 20220320 5

<h4>Background</h4>Patients with chronic obstructive pulmonary disease (COPD) face limited treatment options and inadequate access to palliative care.<h4>Aim</h4>To provide a pragmatic overview of clinical guidelines and produce evidence-based recommendations for severe COPD. Interventions for which there is inconsistent evidence to support their use and areas requiring further research were identified.<h4>Design</h4>Practice review of guidelines supported by scoping review methodology to examin ...[more]

PMID: 35311415

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Project description:BackgroundChronic obstructive pulmonary disease (COPD) is a growing epidemic, with a heavy associated economic burden. Education, physical activity, and pulmonary rehabilitation programs are important aspects of the management of COPD. These interventions are commonly delivered remotely as part of telemedicine interventions. Several systematic reviews and meta-analyses have been conducted to assess the effectiveness of these interventions. However, these reviews often have conflicting conclusions.ObjectiveWe aim to conduct an umbrella review to critically appraise and summarize the available evidence on telemedicine interventions for the management of COPD.MethodsIn this umbrella review, the MEDLINE, Embase, PsycINFO, and Cochrane databases were searched from inception to May 2022 for systematic reviews and meta-analyses relating to telemedicine interventions for the management of COPD. We compared odds ratios, measures of quality, and heterogeneity across different outcomes.ResultsWe identified 7 systematic reviews that met the inclusion criteria. Telemedicine interventions used in these reviews were teletreatment, telemonitoring, and telesupport. Telesupport interventions significantly reduced the number of inpatient days and quality of life. Telemonitoring interventions were associated with significant reductions in respiratory exacerbations and hospitalization rates. Teletreatment showed significant effectiveness in reducing respiratory exacerbations, hospitalization rate, compliance (acceptance and dropout rate), and physical activity. Among studies that used integrated telemedicine interventions, there was a significant improvement in physical activity.ConclusionsTelemedicine interventions showed noninferiority or superiority over the standard of care for the management of COPD. Telemedicine interventions should be considered as a supplement to usual methods of care for the outpatient management of COPD, with the aim of reducing the burden on health care systems.

Dataset Information

Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review.

Background

Aim

Design

Data sources

Results

Conclusions

Publications

Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review.

Similar Datasets

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