Acute exacerbations of chronic obstructive pulmonary disease: current recommendations review and quality of evidence analysis

COPD is a complex disorder characterized by frequent exacerbations causing respiratory failure, antibiotic consumption and the need for the hospital admission. Acute exacerbations of COPD (AE-COPD) are an important cause of hospitalization and death. We analyzed all AE-COPD recommendations issued by different societies in order to collect them in a single document and evaluate its quality. Clinical practice guidelines recommendations regarding AE-COPD were systematically collected from current versions of CPGs released by major international scientific societies (ESCMID, ERS/ATS and GOLD). For each recommendation associated level of evidence was also presented. Thirty-three recommendations were found concerning AE-COPD in studied guidelines: in ESCMID/ERS 2011 guideline 41,9% were based on MA, SR or RCT, in ERS/ATS 2016 guideline no recommendation was considered based on the high quality of evidence and in GOLD 2020 guideline 75% of performed recommendations were based on RCTs. Six recommendations regarding ventilation in AE-COPD were identified. From these, 33,3% were based on high-quality RCTs, 16,7% in RCTs with important limitations and 50% in evidence from observational studies. In conclusion, AE-COPD recommendations based on the high quality of evidence are small, which discloses the importance of increase high-quality research efforts.