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Evidence Base for Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Vincenza Snow, MD; Steven Lascher, DVM, MPH; Christel Mottur-Pilson, PhD, Joint Expert Panel on Chronic Obstructive Pulmonary Disease of the American College of Chest Physicians and the American College of Physicians–American Society of Internal Medicine*
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*This paper, written by Vincenza Snow, MD, Steven Lascher, DVM, MPH, and Christel Mottur-Pilson, PhD, was developed by the Joint Expert Panel on Chronic Obstructive Pulmonary Disease of the American College of Chest Physicians (ACCP) and the American College of Physicians–American Society of Internal Medicine (ACP–ASIM): Peter Almenoff, MD; Paul G. Auwaerter, MD; Sidney Braman, MD; Bart Celli, MD; Alan Fein, MD (Co-Chair); Stan Fiel, MD; David Hudgel, MD; Stephanie Levine, MD; Michael Mandel, MD; Sean Tunis, MD, MSc (Co-Chair); Peter Bach, MD; and Steven Lascher, DVM, MPH. Approved by the ACP–ASIM Board of Regents on 16 July 2000 and by the ACCP Board of Directors on 1 July 2000. This paper will also appear in Chest (2001; volume 119).

Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.

Note: Clinical practice guidelines are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP–ASIM clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.

Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Requests for Single Reprints: Customer Service, American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.

Current Author Addresses: Drs. Snow, Lascher, and Mottur-Pilson: American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.


Ann Intern Med. 2001;134(7):595-599. doi:10.7326/0003-4819-134-7-200104030-00015
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The American College of Physicians–American Society of Internal Medicine (ACP–ASIM) and the American College of Chest Physicians (ACCP) developed this evidence-based clinical practice guideline in collaboration. A joint expert panel examined the evidence and developed recommendations. The numbers in square brackets are cross-references to the numbered sections in the accompanying background paper, “Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Summary and Appraisal of Published Evidence,” which is part 2 of this guideline (see pages 600-620). The guideline and background paper are based primarily on a systematic review compiled in an Agency for Healthcare Research and Policy evidence report prepared by the Evidence-Based Practice Center at Duke University (1). Our target audience is primary care physicians and specialists who care for patients with chronic obstructive pulmonary disease (COPD). Although most acute exacerbations of COPD take place and are treated on an outpatient basis, research studies focus on emergency department or inpatient settings. As a result, this guideline applies to exacerbations treated in those settings. The guideline presents the available evidence on risk stratification for relapse and 6-month mortality rates, diagnostic testing for acute exacerbations of COPD, and current treatment options for acute exacerbations of COPD.

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