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

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

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 recommendeda
ED treatment
Inhaled bronchodilators Recommended Recommended Recommended (level A)
Systemic corticosteroids Recommended Recommendedb 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 addressedc Second-line therapy (level B)d
Discharge medication
Systemic corticosteroids Recommended Recommended Recommended (level A)
  1. ED emergency department, level A randomized controlled trials with rich body of data, level B randomized controlled trials with limited body of data
  2. aChanged from “not clearly addressed” in 2001 guidelines
  3. bChanged from “may be added” in 1995 guidelines
  4. cChanged from “primary agent” in 1995 guidelines
  5. dChanged from “level A recommended treatment” in 2001 guidelines