The American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) have developed a joint evidence-based guideline on preventing acute exacerbations of chronic obstructive pulmonary disease (COPD). Data from randomized controlled trials and guidelines were analyzed and three key questions were established by the PICO (population, intervention, comparator, outcome of interest) format, which addresses the prevention of acute COPD exacerbations as nonpharmacologic, inhaled, and oral treatments. The guideline emphasizes that there is still much unknown about exacerbation prevention, which hinders its ability to "prioritize one type of therapy over another or make recommendations about combinations of therapy to prevent exacerbations." Future research will aim to study combinations of therapies across PICO groups and evaluate their impact on prevention of acute exacerbations.
From Temple University School of Medicine (Dr Criner), Philadelphia, PA; Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre (Dr Bourbeau), Montreal, QC; American College of Chest Physicians (Ms Diekemper), Glenview, IL; Henry Ford Health System (Dr Ouellette), Detroit, MI; College of Medicine, University of Saskatchewan
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