Structured Abstract

Contents

• Key Messages
• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Evidence Summary
  • Background and Objectives
  • Scope and Key Questions
  • Methods
  • Results
  • Discussion
  • References
• Introduction
  • Background
• Methods
  • Literature Search Strategy
• Results
  • Literature Searches and Evidence Base
  • KQ1. In adult patients with exacerbation of COPD, what are the benefits and harms of systemic corticosteroids and antibiotics compared with placebo or standard care?
  • KQ2. In adult patients with exacerbation of COPD, what are the benefits and harms of emerging and other pharmacologic and nonpharmacologic therapies compared with placebo or standard care?
  • KQ3. In adult patients with exacerbation of COPD, what are the benefits and harms of combinations of treatments that are individually effective (based on empirical evidence in stable COPD)?
  • KQ4. In adult patients with exacerbation of COPD, what is the comparative effectiveness of different regimens of antibiotics and systemic corticosteroids based on type of agents (e.g.. broad-spectrum vs. narrow-spectrum antibiotics), delivery modes (e.g., intravenous, oral), and durations of treatment?
• Discussion
  • Overview
  • Findings in Relation to What Is Known
  • Limitations
  • Applicability
  • Suggestions for Future Research
  • Conclusion
• References
• Abbreviations and Acronyms
• Appendixes
  • Appendix A. Flow Chart
  • Appendix B. Search Strategy
  • Appendix C. Excluded Studies
  • Appendix D. Characteristics of Included Studies
  • Appendix E. Risk of Bias
  • Appendix F. Results From Included Studies
  • Appendix G. Results by Severity
  • Appendix H. Adverse Events
  • Appendix I. Inclusion and Exclusion Criteria of Included Studies
  • Appendix J. Sensitivity Analysis
  • Appendix K. Appendix References

Suggested citation:

Dobler CC, Morrow AS, Farah MH, Beuschel B, Majzoub AM, Wilson ME, Hasan B, Seisa MO, Daraz L, Prokop LJ, Murad MH, Wang Z. Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD: A Systematic Review. Comparative Effectiveness Review No. 221. (Prepared by the Mayo Clinic Evidence-based Practice Center under Contract No. 290-2015-00013-I.) AHRQ Publication No. 19(20)-EHC024-EF. Rockville, MD: Agency for Healthcare Research and Quality; October 2019. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCCER221.

This report is based on research conducted by the Mayo Clinic Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00013-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program website at www.effectivehealthcare.ahrq.gov. Search on the title of the report.

People using assistive technology may not be able to fully access information in this report. For assistance contact vog.qrha@CPE.