What’s evidence based and what’s not in the management of COPD exacerbations?

This meta-analysis in Chest was published about a year ago but it’s timely. It belongs on the must read list for hospital medicine. I had seen these data presented before, and was alerted to the paper by a recent posting on Medscape. The management of COPD can seem a little boring when it’s done by habit. It becomes more exciting when we actually look at the evidence about what really makes a difference. From the abstract of the paper:

…systemic corticosteroids are effective in reducing treatment failures, while antibiotics reduce mortality and treatment failures in those requiring hospitalization and NPPV reduces the risk of intubation and in-hospital mortality, especially in those who demonstrate respiratory acidosis.

Notably, antibiotics made a huge difference in mortality. Patient selection for the use of NPPV can be aided by blood gas values as noted in the paper.