Recommendations on Oral Steroid Therapy

Based on low certainty evidence from 4 trials, the ATS panel made a conditional recommendation against the use of maintenance oral corticosteroids in patients with COPD and a history of severe and frequent exacerbations despite otherwise optimal therapy. The studies that provided the evidence for this recommendation did not demonstrate an improvement in clinical outcomes with maintenance oral steroid treatment. These studies, however, featured small sample sizes and were conducted over short periods of time.

Recommendations on Opioid-Based Therapy

Opioid therapy was associated with significant and clinically meaningful improvements in dyspnea in 14 randomized clinical trials of patients with COPD and advanced refractory dyspnea, according to the panel’s review of the literature. Thus, based on the very low certainty evidence available, the ATS recommended that opioid-based therapy could be considered for dyspnea management in patients with COPD who have advanced refractory dyspnea despite otherwise optimal therapy. The panel noted that this treatment should be based on a personalized approach of shared decision making.

Future Directions

In their conclusions, the ATS panel emphasized the need for shared decision making when applying these recommendations as a means of optimizing clinical care. Additionally, the panel wrote that more research is needed to form concrete recommendations on optimal pharmacologic therapy for patients with COPD and varying degrees of eosinophilia as well as for patients who are current and former smokers.

“The panel hopes that the research priorities outlined in this document will prompt new research needed to identify more specific patient profiles in order to provide personalized, patient-centered care,” the guideline committee wrote.


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Reference

Gartman EJ, Mulpuru SS, Mammen MJ, et al. Summary for clinicians: clinical practice guideline on pharmacologic management of chronic obstructive pulmonary disease. Published online September 3, 2020. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.202007-880CME

This article originally appeared on Pulmonology Advisor