title: Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline.
abstract: BACKGROUND
  COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations.
  
  
  METHODS
  In recognition of the importance of preventing exacerbations in patients with COPD, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion.
  
  
  RESULTS
  The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in the field of COPD would lead to a series of recommendations to assist clinicians in their management of the patient with COPD.
  
  
  CONCLUSIONS
  This guideline is unique because it provides an up-to-date, rigorous, evidence-based analysis of current randomized controlled trial data regarding the prevention of COPD exacerbations.
authors.affiliation: Temple University School of Medicine, Philadelphia, PA. Electronic address: gerard.criner@tuhs.temple.edu.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Criner
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.affiliation: American College of Chest Physicians, Glenview, IL.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Diekemper
authors.affiliation: Henry Ford Health System, Detroit, MI.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Ouellette
authors.affiliation: College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Goodridge
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Hernandez
authors.affiliation: School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
authors.forename: Kristen
authors.initials: K
authors.lastname: Curren
authors.affiliation: Canadian Thoracic Society, Ottawa, ON, Canada.
authors.forename: Meyer S
authors.initials: MS
authors.lastname: Balter
authors.affiliation: Division of Respirology, University of Toronto, Toronto, ON, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhutani
authors.affiliation: University of Alberta, Edmonton, AB, Canada.
authors.forename: Pat G
authors.initials: PG
authors.lastname: Camp
authors.affiliation: Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Bartolome R
authors.initials: BR
authors.lastname: Celli
authors.affiliation: Harvard Medical School, Brigham and Women's Hospital, Boston, MA.
authors.forename: Gail
authors.initials: G
authors.lastname: Dechman
authors.affiliation: University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, AL.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dransfield
authors.affiliation: Medical Center/Atlantic Health System, Morristown, NJ.
authors.forename: Stanley B
authors.initials: SB
authors.lastname: Fiel
authors.affiliation: Morehouse School of Medicine, Atlanta, GA.
authors.forename: Marilyn G
authors.initials: MG
authors.lastname: Foreman
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Hanania
authors.affiliation: The Evidence Doc, Pacific, MO.
authors.forename: Belinda K
authors.initials: BK
authors.lastname: Ireland
authors.affiliation: Temple University School of Medicine, Philadelphia, PA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Marchetti
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Darcy D
authors.initials: DD
authors.lastname: Marciniuk
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, OR.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mularski
authors.affiliation: American College of Chest Physicians, Glenview, IL.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ornelas
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Road
authors.affiliation: Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Stickland
mesh_terms: D002170:Canada; D019468:Disease Management; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000517:prevention & control*; D014481:United States