Improved care of acute exacerbation of chronic obstructive pulmonary disease in two academic emergency departments

Table 1 Recommendations for management of acute exacerbation of chronic obstructive pulmonary disease in major clinical guidelines

Process of Care	American College of Chest Physicians & American College of Physicians-American Society of Internal Medicine guidelines (2001) [5]	American Thoracic Society/European Respiratory Society guidelines (updated in 2004) [6]	Global Initiative for Chronic Obstructive Lung Disease (updated in 2007) [4], strength of evidence where indicated
Diagnostic evaluation
Chest radiography	Recommended	Recommended in admitted patients	Recommended
Pulse oximetry	Recommended	Recommended	Recommended
Arterial blood gas	Not clearly addressed	Recommended in admitted patients	Recommended in admitted patients
Acute spirometry	Not recommended	Not addressed	Not recommended^a
ED treatment
Inhaled bronchodilators	Recommended	Recommended	Recommended (level A)
Systemic corticosteroids	Recommended	Recommended^b	Recommended (level A)
Antibiotics	Recommended in severe exacerbations	Recommended in patients with altered sputum purulence and/or volume	Recommended in patients with airway infection (level B)
Methylxanthines	Not recommended	Not addressed^c	Second-line therapy (level B)^d
Discharge medication
Systemic corticosteroids	Recommended	Recommended	Recommended (level A)

ED emergency department, level A randomized controlled trials with rich body of data, level B randomized controlled trials with limited body of data
^aChanged from “not clearly addressed” in 2001 guidelines
^bChanged from “may be added” in 1995 guidelines
^cChanged from “primary agent” in 1995 guidelines
^dChanged from “level A recommended treatment” in 2001 guidelines

ISSN: 1865-1380