Review of clinical guidelines for the management of acute exacerbation of chronic obstructive pulmonary disease in primary care setting

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic condition affecting the respiratory system leading to dyspnea, cough and sputum, and also impacting the quality of life significantly as the condition progresses. It affects more than 400 million people globally and anticipated that the prevalence will continue to increase. The condition is marred by exacerbations intermittently, worsening the symptoms and requiring use of bronchodilators, corticosteroids and where needed the antibiotics. There are many international clinical guidelines available on management of acute exacerbations in COPD and their recommendations.  We compared the available international guidelines on their advice on the management of acute exacerbation of COPD. We selected Global Initiative for Chronic Obstructive Lung Disease (GOLD) report 2026, COPD-X plan: Australian and New Zealand guidelines for the management of COPD 2025, National Institue for Health and Care Excellence (NICE) COPD 2018 guideline and management of COPD exacerbations: European Respiratory Society and Americal Thorasic Society (ERS/ATS) guideline 2017. The 4 guidelines recommendations on use of bronchodilators, corticosteroids and antibiotics during acute exacerbation of COPD are mutually similar and agree on use of these, except ERS/ATS guideline which has not commented on antibiotic use. The dosage of steroids is similar from the guidelines and the choice of antibiotic also. We concluded that bronchodilators, corticosteroids and antibiotics during acute exacerbation of COPD is recommended by major international clinical guidelines.