title: ALAT-2014 Chronic Obstructive Pulmonary Disease (COPD) Clinical Practice Guidelines: questions and answers.
abstract: ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.
authors.affiliation: Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela. Electronic address: montesdeoca.maria@gmail.com.
authors.forename: María
authors.initials: M
authors.lastname: Montes de Oca
authors.affiliation: Universidad de la República, Hospital Maciel, Montevideo, Uruguay.
authors.forename: María Victorina
authors.initials: MV
authors.lastname: López Varela
authors.affiliation: Hospital Universitario de Caracas, Universidad Central de Venezuela, y Centro Médico Docente La Trinidad, Caracas, Venezuela.
authors.forename: Agustín
authors.initials: A
authors.lastname: Acuña
authors.affiliation: Hospital de Rehabilitación Respiratoria «María Ferrer», Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Schiavi
authors.affiliation: Universidad de la República, Hospital Maciel, Montevideo, Uruguay.
authors.forename: María Alejandra
authors.initials: MA
authors.lastname: Rey
authors.affiliation: Universidade Federal de São Paulo, São Paulo, Brasil.
authors.forename: José
authors.initials: J
authors.lastname: Jardim
authors.affiliation: Fundación Neumológica Colombiana, Bogotá, Colombia.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Casas
authors.affiliation: Hospital Central Fuerza Aérea del Perú, Lima, Perú
authors.forename: Antonio
authors.initials: A
authors.lastname: Tokumoto
authors.affiliation: Fundación Neumológica Colombiana, Bogotá, Colombia.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Torres Duque
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Ramírez-Venegas
authors.affiliation: Hospital Rodolfo Rossi, La Plata, Argentina.
authors.forename: Gabriel
authors.initials: G
authors.lastname: García
authors.affiliation: Facultad de Ciencias Médicas, Santa Casa de San Pablo, São Paulo, Brasil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stirbulov
authors.affiliation: Universidade Federal da Bahia e Escola Bahiana de Medicina, Salvador, Brasil.
authors.forename: Aquiles
authors.initials: A
authors.lastname: Camelier
authors.affiliation: Hospital Dr. Antonio Cetrángolo, Vicente López, Buenos Aires, Argentina.
authors.forename: Miguel
authors.initials: M
authors.lastname: Bergna
authors.affiliation: Hospital Centro Médico, Guatemala, Guatemala.
authors.forename: Mark
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Hospital José Gregorio Hernández, Caracas, Venezuela.
authors.forename: Santiago
authors.initials: S
authors.lastname: Guzmán
authors.affiliation: Hospital Universitario de Caracas, Universidad Central de Venezuela, y Centro Médico Docente La Trinidad, Caracas, Venezuela.
authors.forename: Efraín
authors.initials: E
authors.lastname: Sánchez
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004781:Environmental Exposure; D016021:Epidemiologic Studies; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000517:prevention & control; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects; D014611:Vaccination
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists
keywords: Chronic obstructive pulmonary disease (COPD); Clinical practice guideline; Enfermedad pulmonar obstructiva crónica (EPOC); Guía de práctica clínica