Pharmacologic and Non-pharmacologic Therapies in Adult Patients with Acute Exacerbation of COPD: A Systematic Review

Project Summary Title and Description

Title
Pharmacologic and Non-pharmacologic Therapies in Adult Patients with Acute Exacerbation of COPD: A Systematic Review
Description
N/A
Attribution
N/A
Authors of Report
N/A
Methodology description
We developed an analytic framework to guide the process of the systematic review. We followed the established methodologies of systematic reviews as outlined in the Agency for Healthcare Research and Quality (AHRQ) Methods Guide for Comparative Effectiveness Reviews.42 The reporting complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements.43 The study protocol is registered in the international prospective register of systematic reviews (PROSPERO #: 42018111609) and published on the AHRQ Web site (https://effectivehealthcare.ahrq.gov/topics/copd/protocol). The full report details our literature search strategy, inclusion and exclusion criteria, data synthesis, assessments of risk of bias, and strength of evidence (SOE). We graded SOE for health outcomes deemed to be most important or critical, including mortality, dyspnea, quality of life (QoL), need for intubation, repeat exacerbation and/or hospital readmissions and AECOPD resolution (clinical cure, failure). SOE was rated as high when we were very confident that the estimate of effect lies close to the true effect (the body of evidence has few or no deficiencies and judged to be stable). SOE was rated as moderate when we were moderately confident that the estimate of effect lies close to the true effect (the body of evidence has some deficiencies and is judged to be likely stable). SOE was rated as low when we had limited confidence that the estimate of effect lies close to the true effect (the body of evidence has major or numerous deficiencies and is likely unstable). SOE was rated as insufficient when we had no evidence, were unable to estimate an effect, or had no confidence in the estimate of effect).
PROSPERO
42018111609
DOI
10.26300/amqm-qk94
Notes
SRDR-KQ1-1.doc has the baseline characteristics for KQ1 SRDR-KQ2-1.doc has the baseline characteristics for KQ2 SRDR-KQ3-1.doc has the baseline characteristics for KQ3 SRDR-KQ4-1.doc has the baseline characteristics for KQ4 SRDR-ROB-1.dox has the risk of bias for all studies SRDR-results-1dox.dox has the results for all studies
Funding Source
AHRQ

Key Questions

1. KQ1. In adult patients with acute exacerbation of COPD, what are the benefits and harms of systemic corticosteroids and antibiotics compared with placebo or standard care?
2. KQ2. In adult patients with AECOPD, what are the benefits and harms of emerging and other pharmacologic and non-pharmacologic therapies compared with placebo or standard care?
3. KQ3. In adult patients with acute exacerbation of COPD, what are the benefits and harms of combinations of treatments that are individually effective (based on empirical evidence in stable COPD)?
4. KQ4. In adult patients with acute exacerbation of COPD, what is the comparative effectiveness of different regimens of antibiotics and corticosteroids based on type of agents (e.g. broad-spectrum versus narrow-spectrum antibiotics), delivery modes (e.g. intravenous, oral), and durations of treatment?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Effects of insulin-like growth factors and growth hormone on the in vitro proliferation of T lymphocytes.1992
The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation.2018
Effects of different physical therapy programs on perceived health status in acute exacerbation of chronic obstructive pulmonary disease patients: a randomized clinical trial.2018
Effects of an Exercise Intervention in Frail Older Patients with Chronic Obstructive Pulmonary Disease Hospitalized due to an Exacerbation: A Randomized Controlled Trial.2017
The effect of transcutaneous electrical nerve stimulation in patients with acute exacerbation of chronic obstructive pulmonary disease: randomised controlled trial.2017
Acute exacerbations of chronic obstructive pulmonary disease with low serum procalcitonin values do not benefit from antibiotic treatment: a prospective randomized controlled trial.2016
Prulifloxacin vs Levofloxacin for Exacerbation of COPD after Failure of Other Antibiotics.2016
Compare the efficacy of inhaled budesonide and systemic methylprednisolone on systemic inflammation of AECOPD.2015
The effect of vitamin D on COPD exacerbation: a double blind randomized placebo-controlled parallel clinical trial.2015
Zabofloxacin versus moxifloxacin in patients with COPD exacerbation: a multicenter, double-blind, double-dummy, randomized, controlled, Phase III, non-inferiority trial.
Intravenous magnesium sulphate as an adjuvant therapy in acute exacerbations of chronic obstructive pulmonary disease: a single centre, randomised, double-blinded, parallel group, placebo-controlled trial: a pilot study.2015
Erdosteine reduces inflammation and time to first exacerbation postdischarge in hospitalized patients with AECOPD.
Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial.2015
Efficiency and safety of pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease.2015
N-acetylcysteine in patients with COPD exacerbations associated with increased sputum.2015
Two different dosages of nebulized steroid versus parenteral steroid in the management of COPD exacerbations: a randomized control trial.2014
The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial.2014
Benefits of whole body vibration training in patients hospitalised for COPD exacerbations - a randomized clinical trial.2014
Necessity of amoxicillin clavulanic acid in addition to prednisolone in mild-to-moderate COPD exacerbations.2014
Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation.2014
Efficacy of levofloxacin versus cefuroxime in treating acute exacerbations of chronic obstructive pulmonary disease.2013
The impact of specialized physiotherapy methods on BODE index in COPD patients during hospitalization.-- Not Found --
Does high-frequency chest wall oscillation therapy have any impact on the infective exacerbations of chronic obstructive pulmonary disease? A randomized controlled single-blind study.2013
Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial.2013
Prulifloxacin versus levofloxacin in the treatment of severe COPD patients with acute exacerbations of chronic bronchitis.2013
Moxifloxacin versus amoxicillin/clavulanic acid in outpatient acute exacerbations of COPD: MAESTRAL results.2012
Early rehabilitation exercise program for inpatients during an acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial.-- Not Found --
Efficacy of antibiotic therapy for acute exacerbations of mild to moderate chronic obstructive pulmonary disease.2012
Evaluation of the effectiveness of manual chest physiotherapy techniques on quality of life at six months post exacerbation of COPD (MATREX): a randomised controlled equivalence trial.2012
Randomized trial of zileuton for treatment of COPD exacerbations requiring hospitalization.2011
Efficacy of two corticosteroid regimens in acute exacerbation of chronic obstructive pulmonary disease.2011
Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease.2010
Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease.2010
Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial.
Budesonide/formoterol as effective as prednisolone plus formoterol in acute exacerbations of COPD. A double-blind, randomised, non-inferiority, parallel-group, multicentre study.2009
Efficacy of amoxycillin versus amoxycillin/clavulanate in acute exacerbations of chronic pulmonary obstructive disease in primary care.2009
The effectiveness of a bronchial drainage technique (ELTGOL) in COPD exacerbations.2009
Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study.2009
Atomization inhalation of terbutaline and budesonide efficiently improved immunity and lung function of AECOPD patients.2008
Anti-inflammatory effects of combined budesonide/formoterol in COPD exacerbations.2008
Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy.2007
Open-label, randomized comparison trial of long-term outcomes of levofloxacin versus standard antibiotic therapy in acute exacerbations of chronic obstructive pulmonary disease.2007
Three vs. 10 days of amoxycillin-clavulanic acid for type 1 acute exacerbations of chronic obstructive pulmonary disease: a randomised, double-blind study.2007
Levofloxacin 500 mg once daily versus cefuroxime 250 mg twice daily in patients with acute exacerbations of chronic obstructive bronchitis: clinical efficacy and exacerbation-free interval.2007
The role of nebulised budesonide in the treatment of exacerbations of COPD.2007
Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study.2007
Comparison between azithromycin and amoxicillin in the treatment of infectious exacerbation of chronic obstructive pulmonary disease.-- Not Found --
Effect of intravenous magnesium sulfate on chronic obstructive pulmonary disease exacerbations requiring hospitalization: a randomized placebo-controlled trial.2006
Intravenous aminophylline in patients admitted to hospital with non-acidotic exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial.2005
Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation; a randomized controlled feasibility trial.2004
Randomised, controlled trial of N-acetylcysteine for treatment of acute exacerbations of chronic obstructive pulmonary disease ISRCTN21676344.2004
Early mobilization with walking aids following hospital admission with acute exacerbation of chronic obstructive pulmonary disease.2003
Comparison of the efficacy of nebulised budesonide with parenteral corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease.2003
Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease.2003
What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations?2002
Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial.2002
Bronchodilating effect of oxitropium bromide in heart disease patients with exacerbations of COPD: double-blind, randomized, controlled study.2002
Telithromycin is as effective as amoxicillin/clavulanate in acute exacerbations of chronic bronchitis.2002
Systemic glucocorticoids in severe exacerbations of COPD.2001
Does high dose ipratropium bromide added to salbutamol improve pulmonary function for patients with chronic obstructive airways disease in the emergency department?2000
Determination of the etiological organism during acute exacerbations of COPD and efficacy of azithromycin, ampicillin-sulbactam, ciprofloxacin and cefaclor. Turkish Thoracic Society COPD Working Group.1999
Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group.1999
Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial.1999
Locoregional control of tongue base adenoid cystic carcinoma with primary resection and radial forearm free flap reconstruction.2017
Trovafloxacin versus amoxicillin/clavulanic acid in the treatment of acute exacerbations of chronic obstructive bronchitis.1998
Effect of oral antibiotics on lung mucociliary clearance during exacerbation of chronic obstructive pulmonary disease.1998
Impact of nutritional support on functional status during an acute exacerbation of chronic obstructive pulmonary disease.1997
Controlled trial of oral prednisone in outpatients with acute COPD exacerbation.1996
Patients' satisfaction with fast-track surgery in gynaecological oncology.2015
Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease.1995
Comparison of nebulised salbutamol and ipratropium bromide with salbutamol alone in the treatment of chronic obstructive pulmonary disease.1995
Treatment of acute bacterial exacerbations of chronic obstructive pulmonary disease in hospitalised patients--a comparison of meropenem and imipenem/cilastatin. COPD Study Group.1995
A comparison of cefpodoxime proxetil and cefaclor in the treatment of acute exacerbation of COPD in adults.1993
Fibrous dysplasia of right upper jawuncommon presentation.1998
A randomized controlled trial of methylprednisolone in the emergency treatment of acute exacerbations of COPD.1989
Aminophylline for acute exacerbations of chronic obstructive pulmonary disease. A controlled trial.1987
Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.1987
Salbutamol plus beclomethasone dipropionate (Ventolin Flogo) vs. fenoterol (Dosberotec) in chronic obstructive lung disease therapeutic strategy: a 4-week clinical trial.1985
Intravenous aminophylline in the treatment of acute bronchospastic exacerbations of chronic obstructive pulmonary disease.1984
Controlled clinical trial of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency.1980
Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial.2013
Effect of eicosapentaenoic acid on prevention of lean body mass depletion in patients with exacerbation of chronic obstructive pulmonary disease: A prospective randomized controlled trial.2018
A randomized, controlled multicentric study of inhaled budesonide and intravenous methylprednisolone in the treatment on acute exacerbation of chronic obstructive pulmonary disease.2016
Methyl prednisolone vs Dexamethasone in Management of COPD Exacerbation; a Randomized Clinical Trial.2017
Role of Vitamin D Replacement on Health Related Quality of Life in Hospitalized Patients with "Acute Exacerbation of Chronic Obstructive Pulmonary Disease".2018
Evaluation effects of nebulized gentamicin in exacerbation of chronic obstructive lung disease.2016
Automated oxygen titration and weaning with FreeO2 in patients with acute exacerbation of COPD: a pilot randomized trial.2016
Magnesium Sulfate in Exacerbations of COPD in Patients Admitted to Internal Medicine Ward.2014
Short-term effects of chest physiotherapy in acute exacerbation of chronic obstructive pulmonary disease2017
Impact of antibiotics on acute exacerbations of COPD2015
High dose N-acetyl cysteine improves inflammatory response and outcome in patients with COPD exacerbations2013
The effects of a high-fat, low-carbohydrate diet on the prognosis of patients with an acute attack of chronic obstructive pulmonary disease2009
he effect of mechanical vibration in patients with acute exacerbations of chronic obstructive pulmonary disease.1987
Effect of simvastatin on serum gamma-glutamyltransferase and C-reactive protein in patient with acute exacerbation chronic obstructive pulmonary disease.2018
Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease.2000
Exercise training improves recovery in patients with COPD after an acute exacerbation.1998
An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial.2014

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