Chronic Obstructive Pulmonary Disease: Literature Review

Introduction

Chronic obstructive pulmonary disease (COPD) is a widespread inflammatory lung disease that includes conditions such as chronic bronchitis and emphysema. It is the third leading cause of death in the United States (American Lung Association, n.d.). COPD is preventable and treatable with proper management and lifestyle changes. This literature review will investigate COPD treatment protocols.

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Main body

Mathioudakis, Chatzimavridou-Grigoriadou, Corlateanu, and Vestbo (2016) present an article discussing the effectiveness of procalcitonin as a protocol in antibiotic administration for patients with acute exacerbations of COPD. Their thesis is based on the premise that exacerbations in COPD which may be equally caused by bacteria or viruses are treated with antibiotics all the time, which results in their overuse without necessary outcomes.

Procalcitonin serum which is released in response to bacterial infections can be used to guide antibiotic prescriptions. The article is a systematic literature review that the researchers have compiled based on the procalcitonin-based protocol. Methods used were filtering databases for randomized and quasi-randomized trials and used the Cochrane and GRADE scale to evaluate literature for bias and quality of evidence (Mathioudakis et al., 2016).

The authors determined that procalcitonin-based protocols decrease antibiotic prescription and exposure rates with negatively affecting outcomes such as mortality, treatment failure, or recurrence rates. The strength of evidence in this article is supported by the authors’ intention to verify the sources through an evaluation scale. Furthermore, the total sample amongst all the studies exceeded 1,000 COPD patients with acute exacerbations which indicates heterogeneity of findings.

Limitations may include that not all trials may have been utilizing blinded selection in treatment allocation. It is likely that a team of doctors made the final decision on the discretion to use antibiotics, which may create issues with replicating results. Finally, the use of a substance to eliminate a possibility of a virus may present false-negative results for bacterial infection. Overall, the approach taken by the authors is unique and necessary with the overwhelming issue of antibiotic overuse. With further research, this method presents possibilities for more competent protocol treatment of COPD.

Gruffyd-Jones et al. (2016) focus on adherence of treatment protocols to published guidelines on the treatment of COPD. The authors investigate the factors affecting treatment options as well as how therapy has changed over time in the last two decades. Methods include collecting historical clinical data from the national UK patient database with relevant factors such as demographics, lung function, and exacerbation history, and therapy prescribed. Regression models were used for statistical analysis once data was collected (Gruffyd-Jones et al., 2016).

The UK and international guidelines for the treatment of newly diagnosed COPD recommend a multidimensional approach and the use of bronchodilators and inhaled corticosteroids (ICS) depending on the symptoms and airflow experienced by the patient. Authors found that only 45% of patients were prescribed ICS and 28% received no pharmacological treatment within 1 year of diagnosis (Gruffyd-Jones et al., 2016). Furthermore, the ICS monotherapy treatment decreased over time as well, leading to an annual rate of more than 3 exacerbations.

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These results indicate that guidelines are not properly followed, and COPD treatment protocols are not enforced as physicians fail to prescribe proper regimens. The strength of evidence in this study is its large sample size consisting of patient data for over 20,000 patients. The limitations of the study are that it is limited to UK data, which only reflects the cultural attitudes and drug availability in one country. The methodology should be applied to others in order to discern international standards and be compared to guidelines.

Conclusion

COPD is a chronic inflammatory lung condition that requires a complex approach to treatment protocols. However, this literature review indicates that guidelines are often not followed or mistakenly applied, leading to incompetent approaches to treatment through overuse of antibiotics and a monotherapy approach. Solutions require introducing innovative tools to determine and implement COPD treatment that avoids exacerbations.

References

American Lung Association. (n.d.). Chronic obstructive pulmonary disease (COPD). Web.

Gruffydd-Jones, K., Brusselle, G., Jones, R., Miravitlles, M., Baldwin, M., Stewart, R., … Price, D. (2016). Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care: a real-world study. NPJ Primary Care Respiratory Medicine, 26(1). Web.

Mathioudakis, A., Chatzimavridou-Grigoriadou, V., Corlateanu, A., & Vestbo, J. (2016). P51 Clinical effectiveness of procalcitonin based protocols to guide the administration of antibiotics in patients presenting with COPD exacerbations: Systematic review and meta-analysis. Thorax, 71(Suppl 3). Web.

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