Evidence

  • In people with chronic obstructive pulmonary disease, what are the effects of integrated disease management interventions?
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  • How does longer corticosteroid treatment (>7 days) compare with shorter (≤7 days) in people with exacerbations of chronic obstructive pulmonary disease?
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  • How does umeclidinium bromide compare with placebo for people with chronic obstructive pulmonary disease (COPD)?
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  • How does long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) compare with LABA plus inhaled corticosteroid (ICS) for people with stable chronic obstructive pulmonary disease (COPD)?
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  • How does tiotropium compare with ipratropium bromide for people with chronic obstructive pulmonary disease (COPD)?
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  • What are the longer-term (>6 months) effects of inhaled corticosteroids in people with stable chronic obstructive pulmonary disease?
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  • In people with chronic obstructive pulmonary disease (COPD), what are the effects of combined corticosteroid and long-acting beta-agonist (LABA) in one inhaler versus LABA alone?
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  • What are the effects of influenza vaccine in people with chronic obstructive pulmonary disease (COPD)?
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  • In people with chronic bronchitis or chronic obstructive pulmonary disease, how do mucolytic agents compare with placebo?
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  • What are the effects of pulmonary rehabilitation after exacerbation in people with chronic obstructive pulmonary disease?
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  • How does bronchoscopic lung volume reduction compare with medical therapy in people with chronic obstructive pulmonary disease?
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  • What is the impact of airway clearance techniques when treating acute exacerbations of COPD?
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  • What are the effects of airway clearance techniques in people with stable COPD?
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  • How does lung volume reduction surgery compare with usual medical care in people with diffuse emphysema?
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Evidence scores

    Evidence A

    Reduction in exacerbations: there is good-quality evidence that a combination of an anticholinergic plus a short-acting beta-2 agonist is more effective than a short-acting beta-2 agonist alone at reducing COPD exacerbations at 12 weeks. This combination does not seem to be more effective at reducing exacerbations compared with an anticholinergic alone.

    Evidence A

    Lung function: there is good-quality evidence that smoking cessation interventions are more effective than usual care at improving FEV1 in people with COPD at 1 to 5 years and at reducing all-cause mortality at 14.5 years.

    Evidence A

    Reduction in exacerbations: there is good-quality evidence that beta-2 agonists are more effective than placebo at reducing exacerbations at 12 to 52 weeks.

    Evidence A

    Lung function: there is good-quality evidence that theophylline is more effective than placebo at increasing FEV1. However, its usefulness is limited by adverse effects and the need for frequent monitoring of blood concentrations.

    Evidence A

    Lung function: there is good-quality evidence that short-acting beta-2 agonists are more effective than placebo at increasing FEV1 and at improving daily breathlessness scores at 1 week.

    Evidence A

    Reduction in exacerbations: there is good-quality evidence that prophylactic azithromycin reduces the risk of acute exacerbations in patients with stage II, III, or IV COPD. However, when administered for 1 year, the most noted side effect was a decrement in hearing. [146]

    Evidence B

    Lung function: there is medium-quality evidence that ipratropium, a short-acting anticholinergic, is more effective than placebo at improving FEV1 at 12 weeks.

    Evidence B

    Mortality: there is medium-quality evidence that domiciliary oxygen treatment is more effective than no oxygen supplementation at reducing mortality in people with severe daytime hypoxaemia, with continuous oxygen being more effective than nocturnal domiciliary oxygen treatment.

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