1

Guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD),

a systematic search, screening and quality assessment as part of the ADAPTE

process

Authors

Francesca Wuytack,1 Declan Devane,1 Aislinn Conway,1 Melissa McDonnell,1,2 Tim

McDonnell,3 Bernard McCarthy,1

1National University of Ireland, Galway

2Galway University Hospitals, Galway, Ireland

3St. Vincent‘s University Hospital, Dublin, Ireland

2

Acknowledgments

The evidence synthesis centre, commissioned by the Department of Health, Clinical

Effectiveness Unit, undertook the work described in this report. We thank the Steering

Group for this project for their insight and support through the conduct of this work.

This report should be cited as:

Wuytack F, Devane D, Conway A, McDonnell MJ, McDonnell T, McCarthy B (2016).

Guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD), a

systematic search, screening and quality assessment, as part of the ADAPTE process. National

Clinical Effectiveness Committee, Department of Health: Dublin.

3

National Clinical Effectiveness Committee (NCEC)

Clinical effectiveness is a key component of patient safety and quality. The

integration of best evidence in service provision, through clinical effectiveness

processes, promotes healthcare that is up to date, effective and consistent.

The National Clinical Effectiveness Committee (NCEC) is a Ministerial committee

established in 2010 as part of the Patient Safety First Initiative. The NCEC is supported

by the Clinical Effectiveness Unit (CEU), Department of Health. The NCEC is a

partnership between key stakeholders in patient safety and its mission is to provide a

framework for national endorsement of clinical guidelines and audit to optimise

patient and service user care.

Invitations to tender were issued in July 2015 and a public procurement competition

held for the provision of systematic literature reviews and budget impact analysis to

support the development of National Clinical Guidelines. Subsequently, a series of

reports were commissioned by the CEU/NCEC Department of Health. This report is

the second published under this contract. It supports the development of a National

Clinical Guideline on the Management of Chronic Obstructive Pulmonary Disease

(COPD). The guideline proposal was submitted to the NCEC by the HSE National

Clinical Programme for COPD and was prioritised for development as a National

Clinical Guideline.

Two reports have been prepared a) Considerations of International clinical

guidelines to inform an ADAPTE methodology1 and b) Systematic review of the

literature on setting of Pulmonary Rehabilitation.

COPD is a common progressive lung disease and is the commonest disease-specific

cause of emergency admissions of adults to hospital in Ireland. COPD has a

significant impact on the individual, and on primary and secondary care service

providers. In 2013, (the latest year for which OECD data are currently available), the

hospitalisation rate for Ireland was the highest rate among selected OECD

countries.2

Further information on the NCEC and National Clinical Guidelines is available at

www.health.gov.ie/patient-safety/ncec

4

Abstract

Background

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and

treatable disease, characterised by persistent airflow limitation that is usually

progressive and associated with an enhanced chronic inflammatory response in the

airways and the lung to noxious particles or gases.

In developing a national clinical guideline for Ireland, the Guideline Development

Group (GDG) decided to adapt existing guidelines using the ADAPTE process. This

reports outlines the first three parts of the ADAPTE process: the scope, the search and

screening, and the quality assessment.

Search methods

We conducted a comprehensive search to identify relevant guidelines. We

searched PubMed, Embase, CINAHL and DynaMed databases. In addition, we

searched grey literature sources including guideline clearinghouses and national

websites, professional bodies‘ websites, and Google.

Selection criteria

We identified specific PIPOHs (Population, intervention, professionals, outcomes,

healthcare setting) for each set of questions the GDG wished to address through the

ADAPTE process, These PIPOHs (n=5) relate to (1) the pharmacological and (2) non-

pharmacological management of COPD, (3) the management of acute

exacerbations, (4) the use and monitoring of oxygen therapy, and (5) the use of

checklists, bundles and pathways in the care of patients with acute exacerbations

of COPD.

Records were screened by two reviewers independently and a third reviewer

resolved any conflicts.

Quality assessment

We assessed the quality of guidelines with two independent reviewers using the

AGREE II tool3 and average percentage scores were calculated for each of the

seven domains.

5

Main results

A total of 1962 records from the databases and 150 from grey literature resources

were identified, of which 41 met the inclusion criteria. To reduce the number of

guidelines, we screened according to the 8 items of the ‗rigour‘ dimension of the

AGREE II tool. This led to 27 records related to 17 guidelines being included,

published between 2006 and 2016. Overall AGREE II scores ranged from 64.3% to

100%, with the applicability domain scored the lowest most frequently. The NICE

guideline scored the highest in all individual domains and overall.

Conclusion

Many good quality clinical guidelines on the management of COPD have been

published internationally, but the question regarding the most effective checklist,

bundles and pathways for managing acute exacerbations of COPD is largely not

addressed.

6

Table of content

1. Background ...................................................................................................................... 8

2. Methods ........................................................................................................................... 10

2.1. Scope and purpose ................................................................................................... 10

2.1.1. PIPOH tool 1: Pharmacological management of COPD ........................... 10

2.1.2. PIPOH tool 2: Non-Pharmacological management of COPD .................. 11

2.1.3. PIPOH tool 3: Management of acute exacerbations of COPD................ 12

2.1.4. PIPOH tool 4: Oxygen therapy prescription and monitoring in COPD ..... 13

2.1.5. PIPOH tool 5: Pathways, bundles and checklists for managing acute

COPD exacerbations ..................................................................................................... 14

2.2. Search methods ......................................................................................................... 15

2.3. Screening for inclusion ............................................................................................... 15

2.4. Quality assessment ..................................................................................................... 16

3. Results............................................................................................................................... 16

3.1. Search and screening results .................................................................................... 16

3.2. Characteristics and mapping of included guidelines .......................................... 19

3.3. Quality of included guidelines .................................................................................. 26

4. Conclusion ...................................................................................................................... 32

References ............................................................................................................................. 32

List of abbreviations

ADAPTE process Process for adapting clinical guidelines

AGREE II Appraisal of Guidelines, Research & Evaluation (version 2)

CEU Central Effectiveness Unit

COPD Chronic Obstructive Pulmonary Disease

ESC Evidence Synthesis Centre

GDG Guideline Development Group

NCEC National Clinical Effectiveness Committee

NICE National Institute for Health and Care and Excellence

PIPOH Population, Intervention, Professionals, Outcomes,

Healthcare setting and context

7

List of Tables

Table 1. Items of the rigour of development dimension of the AGREE II tool ............... 16

Table 2. Characteristics of included guidelines and mapping of content against

PIPOHs ..................................................................................................................................... 20

Table 3. Quality assessment of included guidelines ......................................................... 27

List of Figures

Figure 1. Overview of ADAPTE process and detailed steps of the three modules in

which the ESC are involved ................................................................................................... 9

Figure 2. Flow diagram of search and screening ............................................................. 18

8

1. Background

Chronic Obstructive Pulmonary Disease (COPD) is ―a common, preventable and

treatable disease, characterized by persistent airflow limitation that is usually

progressive and associated with an enhanced chronic inflammatory response in the

airways and the lung to noxious particles or gases‖.4

Many clinical guidelines exist internationally that address the management of

COPD, but none specifically adopted to the Irish context. In developing a national

clinical guideline for Ireland, the Guideline Development Group (GDG) decided to

adapt existing guidelines using the ADAPTE process.1

The Evidence Synthesis Centre conducted three parts of the ADAPTE process, which

we have presented in this report: (1) Assisting the guideline group in defining the

scope and purpose of the guideline; (2) Conducting a systematic search for existing

guidelines; and (3) Assessing the quality of included guidelines. An overview of the

role of the ESC is provided in Figure 1.

9

Figure 1. Overview of ADAPTE process and detailed steps of the three modules in which the ESC are involved

ADAPTE Process and the Evidence Synthesis Centre’s role

Mod

ules

2.1

Scop

e &

Pu

rpos

e

2.2

Sear

ch &

Sc

reen

2.3

Ass

essm

ent

2. Adaptation Phase1. Preliminary Phase 3. Finalisation Phase

Adaptation Phase

Adaptation Phase

Adaptation Phase

2.1 Scope & Purpose module

2.2 Search & Screen module

2.3 Assessment

module

2.4 Decision & Selection

1.1 Preparation module

2.5 Customisation

module

3.1 External Review module

3.2 Aftercare planning module

3.3 Final Production

module

(a) Determine Scope: PIPOH (Section 2.1)GDG + ESC

(b) Determine health questions

(Section 2.1)GDG + ESC

(c) Summarise guideline content

(Table 2)ESC

(a) Search for relevant documents

(Section 3.1)ESC

(b) Screen (Section 3.1)

ESC (+ GDG clinical expertise input

regarding relevance of guidelines)

(a) Quality assessment:

AGREE II (Table 3)ESC

(d) Consider reducing number of guidelines (Section

2.3)GDG + ESC

(b) Currency assessment

GDG (+ ESC to provide briefing on

report)

(c) Content assessment

GDG (+ESC to provide templates

and training)

(d) Consistency assessment

GDG (+ESC to provide templates

and training)

(e) Acceptability and applicability assessment

GDG (+ESC to provide templates

and training)

10

2. Methods

The methods, described in this section, were adapted from ADAPTE collaboration

manual1. Data extraction tool and quality assessment tools were also adapted from

the CAN-IMPLEMENT© toolkit, which uses the ADAPTE process and was originally

developed for the Canadian Guideline Adaptation Group.5 These toolkits are

available in the reference links provided.

2.1. Scope and purpose

The PIPOH format and corresponding health questions were used to define the

scope of the prospective guideline. This specifies the Population and Intervention(s)

of interest, Professionals targeted by the guideline, Outcomes and the Health care

setting and context in which the guideline is to be implemented. Five PIPOHs were

identified (Sections 2.1.1-2.1.5).

2.1.1. PIPOH tool 1: Pharmacological management of COPD

POPULATION (Specify patient and condition characteristics)

Age

Age over 35

Clinical circumstances

Patients diagnosed with COPD (i.e. confirmed as having COPD on spirometry)

Gender

Male or female

INTERVENTIONS (Specify intervention(s) type(s) and characteristics)

Treatments/care

Pharmacological interventions (including beta agonists (LABAs), long acting

muscarinic agents (LAMAs), inhaled corticosteroids (ICSs) and

phosphodiesterase-4 inhibitors)

Follow up

Any follow up time between receiving the diagnosis of COPD and death

PROFESSIONALS/(PATIENTS) (Targeted users)

Providers

Physicians, nurse prescribers

Stakeholders

Dept. of Health, HSE, hospitals, primary care

Patients

Patients with COPD

OUTCOME (Purpose of the guideline)

Patient outcomes

Survival, mortality, exacerbations, hospitalisations, readmissions, morbidity

(disease-specific quality of life, exercise tolerance, lung function e.g. FEV1)

11

System outcomes

Reduce direct and indirect system costs

Public health outcomes

Mortality and morbidity as above

HEALTH CARE SETTING/CONTEXT

Organisations

Hospitals and primary care

HEALTH QUESTION 1

What pharmacological interventions (beta agonists (LABAs), long acting

muscarinic agents (LAMAs), inhaled corticosteroids (ICSs) and phosphodiesterase-

4 inhibitors) are effective at reducing mortality and morbidity in patients over 35

years of age with COPD?

2.1.2. PIPOH tool 2: Non-Pharmacological management of COPD

POPULATION (Specify patient and condition characteristics)

Age

Age over 35

Clinical circumstances

Patients diagnosed with COPD (i.e. confirmed as having COPD on spirometry)

Gender

Male or female

INTERVENTIONS (Specify intervention(s) type(s) and characteristics)

Treatments/care

Non pharmacological interventions (including pulmonary rehabilitation, oxygen

therapy, vaccinations)

Follow up

Any follow up time between receiving the diagnosis of COPD and death

PROFESSIONALS/(PATIENTS) (Targeted users)

Providers

Physicians, nurse prescribers, physiotherapists

Stakeholders

Dept. of Health, HSE, hospitals, primary care

Patients

Patients with COPD

OUTCOME (Purpose of the guideline)

Patient outcomes

Survival, mortality, exacerbations, hospitalisations, readmissions, morbidity

(disease-specific quality of life, exercise tolerance, lung function e.g. FEV1)

System outcomes

Reduce direct and indirect system costs

Public health outcomes

Mortality and morbidity as above

HEALTH CARE SETTING/CONTEXT

12

Organisations

Hospitals and primary care

HEALTH QUESTION 2

What non pharmacological agents (such as pulmonary rehabilitation, oxygen

therapy and vaccinations) are effective at reducing mortality and morbidity in

patients over 35 years of age with COPD?

2.1.3. PIPOH tool 3: Management of acute exacerbations of COPD

POPULATION (Specify patient and condition characteristics)

Age

Age over 35

Clinical circumstances

Patients diagnosed with COPD (i.e. confirmed as having COPD on spirometry)

experiencing an acute exacerbation

Gender

Male or female

INTERVENTIONS (Specify intervention(s) type(s) and characteristics)

Treatments/care

Pharmacological and non-pharmacological interventions (including nebulised

bronchodilators, steroids, antibiotics, chest physiotherapy)

Follow up

Follow up time of up to 30 days post-exacerbation

PROFESSIONALS/(PATIENTS) (Targeted users)

Providers

Physicians, nurse prescribers, physiotherapists

Stakeholders

Dept. of Health, HSE, hospitals, primary care

Patients

Patients with COPD

OUTCOME (Purpose of the guideline)

Patient outcomes

Survival, mortality, readmissions, morbidity (disease-specific quality of life,

exercise tolerance,)

Duration of episode of the exacerbation

System outcomes

Costs related to hospitalisation due to exacerbation.

Public health outcomes

Mortality and morbidity as above

HEALTH CARE SETTING/CONTEXT

Organisations

Hospitals and primary care

HEALTH QUESTION 3

13

What interventions (nebulised bronchodilators, steroids, antibiotics, chest

physiotherapy) are effective at reducing mortality and morbidity in patients over

35 years of age with exacerbations of COPD?

2.1.4. PIPOH tool 4: Oxygen therapy prescription and monitoring in COPD

POPULATION (Specify patient and condition characteristics)

Age

Age over 35

Clinical circumstances

Patients diagnosed with COPD (i.e. confirmed as having COPD on spirometry)

Gender

Male or female

INTERVENTIONS (Specify intervention(s) type(s) and characteristics)

Treatments/care

Prescription and monitoring of oxygen therapy

Follow up

Any follow up time between prescription of oxygen and death

PROFESSIONALS/(PATIENTS) (Targeted users)

Providers

Physicians, nurse prescribers, physiotherapists

Stakeholders

Dept. of Health, HSE, hospitals, primary care

Patients

Patients with COPD

OUTCOME (Purpose of the guideline)

Patient outcomes

Survival, mortality, readmissions, morbidity (disease-specific quality of life,

exercise tolerance, lung function e.g. FEV1), less hazard for patients due to

inappropriate prescription

System outcomes

Costs for prescription of oxygen,

Public health outcomes

Mortality and morbidity as above

HEALTH CARE SETTING/CONTEXT

Organisations

Hospitals and primary care, ambulatory care/home care

HEALTH QUESTION 4

What is the appropriate prescription of oxygen therapy effective to reduce

mortality and morbidity for patients over 35 years of age with COPD, and what are

the optimal monitoring strategies and assessment frequency for patients receiving

oxygen therapy?

14

2.1.5. PIPOH tool 5: Pathways, bundles and checklists for managing acute COPD

exacerbations

POPULATION (Specify patient and condition characteristics)

Age

Age over 35

Clinical circumstances

Patients diagnosed with COPD (i.e. confirmed as having COPD on spirometry),

admitted to hospital with an acute exacerbation

Gender

Male or female

INTERVENTIONS (Specify intervention(s) type(s) and characteristics)

Treatments/care

Any clinical pathway, admission and discharge bundle or checklist used for the

management of acute exacerbations of COPD in hospital.

Care bundles, defined as a structured way of improving the processes of care

and patient outcomes: a small, straightforward set of evidence-based practices

— generally three to five — that, when performed collectively and reliably, have

been proven to improve patient outcomes (HIQA, 2014 ).

Checklists, defined as tools that condense a large volume of information and

allow for systematic verification of steps or practices (Hewson et al., 2006; Hales et

al., 2008; WHO 2008).

Patient care pathways are defined as a multidisciplinary care plan that outlines

the main clinical interventions that are carried out by different healthcare

practitioners for patients with a specific condition or set of symptoms. They are

usually locally agreed, evidenced-based plans that can incorporate local and

national guidelines into everyday practice (NCEC, HIQA, 2015).

Follow up

From hospital admission to 90 days post discharge (readmissions)

PROFESSIONALS/(PATIENTS) (Targeted users)

Providers

Physicians, nurse prescribers, physiotherapists

Stakeholders

Dept. of Health, HSE, hospitals

Patients

Patients with COPD

OUTCOME (Purpose of the guideline)

Patient outcomes

Length of stay in hospital, readmissions, survival, mortality, possibly morbidity

(disease-specific quality of life, exercise tolerance,)

System outcomes

Direct and indirect costs related to length of hospital stay and readmissions.

Public health outcomes

Mortality and morbidity related to COPD

HEALTH CARE SETTING/CONTEXT

15

Organisations

Hospitals

HEALTH QUESTION 5

In patients admitted to hospital with an acute exacerbation of COPD, which

clinical pathways, admission and discharge bundles or checklists are most

effective at improving patient care by reducing length of hospital stay and

readmissions and by reducing patient mortality and morbidity?

2.2. Search methods

We conducted a comprehensive search to identify relevant guidelines. We

searched PubMed, Embase, CINAHL and DynaMed databases. In addition, we

searched grey literature sources including guideline clearinghouses and national

websites, professional bodies‘ websites, and Google. Searches were limited to

guidelines published in English in the last 10 years. Full details of the search strategy

are provided in Appendix 1.

2.3. Screening for inclusion

All retrieved records were screened by at least two reviewers independently (FW,

BW, MM), using the PIPOH criteria. Consensus was reached by involving a third

reviewer (DD).

Due to the large number of guidelines meeting the inclusion criteria, a second round

of screening was conducted to reduce the number of guidelines to be made

available to the GDG. This was based on the ‗Rigour of Development‘ dimension of

the AGREE II quality assessment tool,3 as recommended in the ADAPTE manual.1 The

Rigour of Development dimension contains eight items (Table 1). Guidelines were

included only if they met all items 1-6. This was again conducted independently by

two reviewers (FW, BM) who subsequently discussed and resolved any

discrepancies.

16

Table 1. Items of the rigour of development dimension of the AGREE II tool

1. Systematic methods were used to search for evidence.

2. The criteria for selecting the evidence are clearly described.

3. The strengths and limitations of the body of evidence are clearly described.

4. The methods for formulating the recommendations are clearly described.

5. The health benefits, side effects, and risks have been considered in formulating

the recommendations.

6. There is an explicit link between the recommendations and the supporting

evidence.

7. The guideline has been externally reviewed by experts prior to its publication.

8. A procedure for updating the guideline is provided.

For all included guidelines, we then summarised the guideline characteristics and

mapped which PIPOH(s) they addressed (see table 2).

2.4. Quality assessment

Two reviewers (FW, BM) independently assessed the quality of included guidelines

using the AGREE II instrument3. Scores were calculated and reported in accordance

with the AGREE II manual, including the average percentage score and the overall

assessment score. Inter-rater agreement was also assessed by subtracting the scores

of the two reviewers, and, if there was a difference of more than two for any item,

this was discussed to reach consensus.

3. Results

3.1. Search and screening results

We identified 1962 records from searching databases. The information specialist

(AC) sifted all 1962 records and removed duplicates, leaving 558 records to screen.

Following title and abstract screening, 553 records were excluded. The remaining 25

records were screened at full-text. In addition, we identified 150 records from grey

literature resources, of which 54 were screened at full-text level. Thirty-eight records

of the total of 79 were excluded at full-text. The most common reason for exclusion

was that a record was not a clinical guideline (n=22); using the NCEC‘s definition1.

1 “Clinical Guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances, across the entire clinical spectrum.” Available at: http://health.gov.ie/wp-content/uploads/2015/11/NCEC-Standards-for-Clinical-Practice-Guidance.-Nov-2015.pdf

17

Documents that were not guidelines but thought to be of interest to the guideline

committee (n=12) were not included but are listed in this report for GDG information

(Appendix 2). Following screening based on the rigour of development dimension of

the AGREE II tool, 27 records that related to 17 guidelines met the inclusion criteria

and were included for complete quality assessment and mapping of the content

according to the scope (Sections 3.2 and 3.3). An overview of the search results is

presented in Figure 2.

18

Figure 2. Flow diagram of search and screening

19

3.2. Characteristics and mapping of included guidelines

The characteristics of the 17 included guidelines are presented in Table 2. Guidelines

are ordered chronologically (newest first) and records that refer to the same

guideline are colour-coded in the same colour. We also identified the PIPOHs

addressed in each guideline. The first PIPOH related to the pharmacological

management of stable COPD was addressed in eight guidelines. Aspects of the

second PIPOH (non-pharmacological management of stable COPD) was included

in 14 guidelines. Nine guidelines provided recommendations on the acute

management of COPD (PIPOH 3) and 11 addressed oxygen therapy (PIPOH 4). Only

one guideline made some statement regarding discharge bundles (GOLD 2017;

pp108) and this was only in the most recent version, which we obtained through

clinical experts in the Guideline Development Group. However, some of the

additional non-guideline documents provided in Appendix 2 might be useful in

addressing this final PIPOH.

20

Table 2. Characteristics of included guidelines and mapping of content against PIPOHs

GUIDELINE CHARACTERISTICS HEALTH

QUESTIONS/PIPOHs

addressed

Reference Link Publisher Country

(language)

Publication

date (most

recent first)

End of

search date

1 2 3 4 5 Tota

l no

.

1 Global Strategy for

Diagnosis, Management,

and Prevention of COPD –

2017.

http://goldcopd.org/global-strategy-

diagnosis-management-prevention-

copd-2016

GOLD Internatio-

nal (English)

2017 2016 v v v v (v) 4 +1

2 Hardinge M, Annandale J,

Bourne S, Cooper B, Evans

A, Freeman D, et al. British

Thoracic Society

guidelines for Home

Oxygen use in adults.

Thorax. 2015;70:i1-i43.

https://www.brit-

thoracic.org.uk/document-

library/clinical-

information/oxygen/home-oxygen-

guideline-(adults)/bts-guidelines-for-

home-oxygen-use-in-adults/

British

Thoracic

Society (NICE

accredited)

UK (English) Jun-15 From 1980

to January

2014

v v 2

Hardinge M,

Suntharalingam J,

Wilkinson T. Guideline

update: The British

Thoracic Society

Guidelines on home

oxygen use in adults.

Thorax. 2015;70(6):589-91.

Linked to

above

3 AARC clinical practice

guideline: effectiveness of

pharmacologic airway

clearance therapies in

hospitalized patients.

American Association for

Respiratory Care. 2015.

http://www.rcjournal.com/cpgs/pdf/Ph

arm_CPG.pdf American

Association

for

Respiratory

Care.

USA

(English)

Jul-15 From 1970

to July 2014.

Refers to:

Sathe et al

2015

systematic

review

v v 2

21

GUIDELINE CHARACTERISTICS HEALTH

QUESTIONS/PIPOHs

addressed

4 Prevention of acute

exacerbations of chronic

obstructive pulmonary

disease: American

College of Chest

Physicians and Canadian

Thoracic Society

Guideline. 2015.

http://journal.publications.chestnet.org

/data/Journals/CHEST/933666/chest_14

7_4_894.pdf

American

College of

Chest

Physicians

and

Canadian

Thoracic

Society

USA and

Canada

(English)

Apr-15 30-Jan-13 v v 2

5 Clinical Practice Guideline

on Adult Domiciliary

Oxygen Therapy:

Executive summary from

the Thoracic Society of

Australia and New

Zealand. 2016. (But

published as a report in

2014)

http://www.thoracic.org.au/journal-

publishing/command/download_file/id

/33/filename/TSANZ-

DomiciliaryOxygen-Guidelines-2016-

web.pdf

Thoracic

Society of

Australia and

New Zealand

Australia

and New

Zealand

(English)

Mar-14 Mar-13 v v 2

6 British Thoracic Society

(BTS) guideline on

pulmonary rehabilitation in

adults: Accredited by

NICE. 2013.

http://www.ncbi.nlm.nih.gov/pubmed/

23880483 British

Thoracic

Society

UK (English) 2013 From 1980

to

September

2012

v 1

7 Managing dyspnea in

patients with advanced

chronic obstructive

pulmonary disease: A

Canadian Thoracic

Society clinical practice

guideline. 2011.

http://www.respiratoryguidelines.ca/sit

es/all/files/2011_CTS_guideline_COPD_

dyspnea.pdf

Canadian

Thoracic

Society

Canada

(English)

Apr-11 From

January

1996 to

March 2009

v v v 3

8 Diagnosis and

Management of Stable

Chronic Obstructive

Pulmonary Disease: A

Clinical Practice Guideline

from the American

College of Physicians,

American College of

http://www.thoracic.org/statements/re

sources/copd/179full.pdf editorial:

http://www.ncbi.nlm.nih.gov/pubmed/

21810704 commentary:

http://www.ncbi.nlm.nih.gov/pubmed/

22213504

American

College of

Physicians,

American

College of

Chest

Physicians,

American

Internatio-

nal (English)

2011 Dec-09 v v v v 4

22

GUIDELINE CHARACTERISTICS HEALTH

QUESTIONS/PIPOHs

addressed

Chest Physicians,

American Thoracic

Society, and European

Respiratory Society. 2011.

Thoracic

Society, and

European

Respiratory

Society

9 Department of Veterans

Affairs/Department of

Defense (VA/DoD) clinical

practice guideline on

management of

outpatient COPD. 2015.

http://www.healthquality.va.gov/guide

lines/CD/copd/VADoDCOPDCPG.pdf Department

of Veterans

Affairs/Depar

tment of

Defense

USA

(English)

Dec-14 Feb-14 v v v v 4

Institute for Clinical

Systems Improvement

(ICSI); Chronic Obstructive

Pulmonary Disease

(COPD), Diagnosis and

Management of. 2016.

https://www.icsi.org/_asset/yw83gh/C

OPD.pdf Linked to

above

Ontario Guidelines

Advisory Committee

(GAC) Recommended

Clinical Practice

Guidelines. COPD:

Exacerbation.

http://www.gacguidelines.ca/site/GAC

_Guidelines/assets/pdf/COPD06_-

_Summary_-_Exacerbation-1.pdf

Linked to

above

Ontario Guidelines

Advisory Committee

(GAC) Recommended

Clinical Practice

Guidelines. COPD:

Improving Survival.

http://www.gacguidelines.ca/site/GAC

_Guidelines/assets/pdf/COPD07_-

_Summary_-_Survival.pdf

Linked to

above

Ontario Guidelines

Advisory Committee

(GAC) Recommended

Clinical Practice

Guidelines. COPD

(Stable): Treatment.

http://www.gacguidelines.ca/site/GAC

_Guidelines/assets/pdf/COPD06_-

_Summary_-_Treatment.pdf

Linked to

above

23

GUIDELINE CHARACTERISTICS HEALTH

QUESTIONS/PIPOHs

addressed

10 Canadian Medical

Association Infobase,

Clinical practice

guidelines for the use of

noninvasive positive-

pressure ventilation and

noninvasive continuous

positive airway pressure in

the acute care setting.

2011.

http://www.cmaj.ca/content/early/201

1/02/14/cmaj.100071.full.pdf+html Canadian

Medical

Association

Canada

(English)

14-Feb-14 Jun-09 v v 2

11 McKim DA, Road J,

Avendano M, Abdool S,

Côté F, Duguid N, et al.

Home mechanical

ventilation: A Canadian

Thoracic Society clinical

practice guideline.

Canadian respiratory

journal. 2011;18(4):197-215.

(PDF in dropbox folder provided) Canadian

Thoracic

Society

Canada

(English)

Aug-11 From 1980

to June

2010

v v 2

12 CTS Guideline Optimizing

pulmonary rehabilitation in

chronic obstructive

pulmonary disease -

practical issues. 2010.

http://www.respiratoryguidelines.ca/20

10-cts-guideline-optimizing-pulmonary-

rehabilitation-in-chronic-obstructive-

pulmonary-disease-prac

Canadian

Thoracic

Society

Canada

(English)

Aug-10 From 1990

to April 2009

v 1

13 National Institute for

Health and Care

Excellence (NICE) CG101:

Chronic obstructive

pulmonary disease in over

16s: diagnosis and

management. 2010.

(+2012 evidence update;

second link)

https://www.nice.org.uk/guidance/cg1

01/resources/chronic-obstructive-

pulmonary-disease-in-over-16s-

diagnosis-and-management-

35109323931589;

https://www.nice.org.uk/guidance/cg1

01/evidence/full-guideline-134519581;

http://www.nice.org.uk/guidance/cg1

01/evidence/cg101-chronic-

obstructive-pulmonary-disease-

updated-evidence-update2

NICE UK (English) 23-Jun-10 (+2012,

2013, 2015

update)

They did

also a

review

update in

April 2016

and are

currently

working on

this new

update.

v v v v 4

24

GUIDELINE CHARACTERISTICS HEALTH

QUESTIONS/PIPOHs

addressed

National Institute for

Health and Care

Excellence (NICE)

National costing report:

chronic obstructive

pulmonary disease:

Implementing NICE

Guidance. 2011.

https://workspace.imperial.ac.uk/ref/P

ublic/UoA%2001%20-

%20Clinical%20Medicine/NICE%20costi

ng%20report%20COPD.pdf

Linked to

above

National Institute for

Health and Clinical

Excellence (NICE)

Evidence Update 5 –

Chronic obstructive

pulmonary disease.

February 2012.

http://copdx-writing-group-

meetings.wikispaces.com/file/view/NIC

E_COPD_Evidence_Update_Feb_2012.

pdf/377552418/NICE_COPD_Evidence_

Update_Feb_2012.pdf

Linked to

above

Pathway: Chronic

obstructive pulmonary

disease.

https://pathways.nice.org.uk/pathways

/chronic-obstructive-pulmonary-

disease

Linked to

above

Quality Standard QS10:

Chronic obstructive

pulmonary disease in

adults (QS10). 2011. (+ see

more info in second link)

https://www.nice.org.uk/guidance/qs1

0/resources/chronic-obstructive-

pulmonary-disease-in-adults-

2098478592709;

https://www.nice.org.uk/guidance/qs1

0

Linked to

above

14 Non-invasive ventilation in

chronic obstructive

pulmonary disease. Royal

College of Physicians of

London – RCP. 2008.

https://www.rcplondon.ac.uk/guideline

s-policy/non-invasive-ventilation-

chronic-obstructive-pulmonary-disease

Royal

College of

Physicians

UK (English) Oct-08 From 1988

to date of

search (not

stated)

v v 2

15 2008 Update CTS

Guideline - Highlights for

Primary Care -

Recommendations for

Management of COPD.

http://www.respiratoryguidelines.ca/sit

es/all/files/CTS_COPD_Highlights_2008.p

df commentary:

http://www.ncbi.nlm.nih.gov/pubmed/

18666343

Canadian

Thoracic

Society

Canada

(English)

Feb-08 ‗To present' v v v v 4

25

GUIDELINE CHARACTERISTICS HEALTH

QUESTIONS/PIPOHs

addressed

2007 Update CTS

Guideline -

Recommendations for

Management of COPD.

http://www.respiratoryguidelines.ca/sit

es/all/files/CTS_COPD_Guidelines_2007_

Update.pdf

Linked to

above

Sept-07 From 2003

‗to present‘

16 British Thoracic Society

(BTS) guideline on

emergency oxygen use in

adult patients. 2008 +

correction: Thorax 2009

Jan;64(1):91. Commentary

http://www.ncbi.nlm.nih.gov/pubmed/

18838559;

http://www.ncbi.nlm.nih.gov/pubmed/

18820112

British

Thoracic

Society

UK (English) Jun-08 end 2007 v v v 3

17 British Thoracic Society.

Intermediate care—

Hospital-at-Home in

chronic obstructive

pulmonary disease: British

Thoracic Society

guideline. 2007.

http://thorax.bmj.com/content/62/3/20

0.full.pdf British

Thoracic

Society

UK (English) Nov-06 From 1966

to April 2005

v 1

26

3.3. Quality of included guidelines

The findings of the quality assessment of the 17 included guidelines are presented in

table 3. The average percentage score for each domain of the AGREE II tool and

the average overall percentage score judgement is also provided.3

If a procedure to update the guideline was provided, then this item (item 14) of the

rigour domain was judged satisfactory in accordance with the AGREE II manual,

even if no recent version of the guideline had been published. Hence, we

recommend to look at the date of publication of the guidelines as well as the rating.

We have ordered the guidelines chronologically for your convenience. Overall

AGREE II scores ranged from 64.3% to 100%, and the applicability domain scored the

lowest most frequently. The NICE guideline scored the highest in all domains and

overall.

27

Table 3. Quality assessment of included guidelines

No Guideline (most recent first) AGREE II domains (Standardised domain scores: average percentage scores for each domain)

Scope &

Purpose

(1)

Stakeholder

involvement

(2)

Rigour of

development

(3)

Clarity &

presentation

(4)

Applicability

(5)

Editorial

independence

(6)

Overall

assessment

(7)

Recommend?

1 Global Strategy for Diagnosis,

Management, and

Prevention of COPD – 2017.

100 100 100 100 50 50 89.3 Yes

2 Hardinge M, Annandale J,

Bourne S, Cooper B, Evans A,

Freeman D, et al. British

Thoracic Society guidelines

for Home Oxygen use in

adults. Thorax. 2015;70:i1-i43.

100 100 100 100 65 100 92.3 Yes

Hardinge M, Suntharalingam

J, Wilkinson T. Guideline

update: The British Thoracic

Society Guidelines on home

oxygen use in adults. Thorax.

2015;70(6):589-91.

3

AARC clinical practice

guideline: effectiveness of

pharmacologic airway

clearance therapies in

hospitalized patients.

American Association for

Respiratory Care. 2015.

100 64 65 97 10 50 64.3 Yes with

modification

4 Prevention of acute

exacerbations of chronic

obstructive pulmonary

disease: American College of

Chest Physicians and

Canadian Thoracic Society

Guideline. 2015.

100 100 100 100 38 50 85.7 Yes

5 Clinical Practice Guideline

on Adult Domiciliary Oxygen

Therapy: Executive summary

100 33 100 100 13 50 75 Yes

28

from the Thoracic Society of

Australia and New Zealand.

2016. (But published as a

report in 2014)

6 British Thoracic Society (BTS)

guideline on pulmonary

rehabilitation in adults:

Accredited by NICE. 2013.

100 100 100 100 52 50 92.9 Yes

7 Managing dyspnea in

patients with advanced

chronic obstructive

pulmonary disease: A

Canadian Thoracic Society

clinical practice guideline.

2011.

100 67 100 100 25 100 85.7 Yes

8 Diagnosis and Management

of Stable Chronic Obstructive

Pulmonary Disease: A Clinical

Practice Guideline from the

American College of

Physicians, American College

of Chest Physicians,

American Thoracic Society,

and European Respiratory

Society. 2011.

100 67 100 100 0 100 85.7 Yes

9 Department of Veterans

Affairs/Department of

Defense (VA/DoD) clinical

practice guideline on

management of outpatient

COPD. 2015.

100 100 99 100 60 100 85.7 Yes

Institute for Clinical Systems

Improvement (ICSI); Chronic

Obstructive Pulmonary

Disease (COPD), Diagnosis

and Management of. 2016.

29

Ontario Guidelines Advisory

Committee (GAC)

Recommended Clinical

Practice Guidelines. COPD:

Exacerbation.

Ontario Guidelines Advisory

Committee (GAC)

Recommended Clinical

Practice Guidelines. COPD:

Improving Survival.

Ontario Guidelines Advisory

Committee (GAC)

Recommended Clinical

Practice Guidelines. COPD

(Stable): Treatment.

10 Canadian Medical

Association Infobase, Clinical

practice guidelines for the

use of noninvasive positive-

pressure ventilation and

noninvasive continuous

positive airway pressure in

the acute care setting. 2011.

100 61 100 100 27 100 85.7 Yes

11 McKim DA, Road J,

Avendano M, Abdool S, Côté

F, Duguid N, et al. Home

mechanical ventilation: A

Canadian Thoracic Society

clinical practice guideline.

Canadian respiratory journal.

2011;18(4):197-215.

100 89 100 100 0 100 85.7 Yes

12 CTS Guideline Optimizing

pulmonary rehabilitation in

chronic obstructive

pulmonary disease -

practical issues. 2010.

100 67 88 100 0 100 85.7 Yes

30

13 National Institute for Health

and Care Excellence (NICE)

CG101: Chronic obstructive

pulmonary disease in over

16s: diagnosis and

management. 2010. (+2012

evidence update; second

link)

100 100 100 100 94 100 100 Yes

National Institute for Health

and Care Excellence (NICE)

National costing report:

chronic obstructive

pulmonary disease:

Implementing NICE

Guidance. 2011.

National Institute for Health

and Clinical Excellence

(NICE) Evidence Update 5 –

Chronic obstructive

pulmonary disease. February

2012.

Pathway: Chronic obstructive

pulmonary disease.

Quality Standard QS10:

Chronic obstructive

pulmonary disease in adults

(QS10). 2011. (+ see more info

in second link)

14 Non-invasive ventilation in

chronic obstructive

pulmonary disease. Royal

College of Physicians of

London – RCP. 2008.

94 97 84 100 21 54 78.6 Yes

15 2008 Update CTS Guideline -

Highlights for Primary Care -

Recommendations for

Management of COPD. 100 50 100 100 25 100 75.0 Yes

2007 Update CTS Guideline -

Recommendations for

Management of COPD.

31

16 British Thoracic Society (BTS)

guideline on emergency

oxygen use in adult patients.

2008 + correction: Thorax

2009 Jan;64(1):91.

Commentary

100 100 100 100 75 50 92.3 Yes

17 British Thoracic Society.

Intermediate care—Hospital-

at-Home in chronic

obstructive pulmonary

disease: British Thoracic

Society guideline. 2007.

100 64 80 100 60 0 85.7 Yes

32

4. Conclusion

Numerous guidelines regarding the management of COPD have been produced

worldwide; however, many were not developed rigorously. Based on the selection

criteria and subsequent screening of the quality of development, we included 17

guidelines. Of the guidelines that addressed at least four of the five PIPOHs, the NICE

guideline scored the highest in quality, followed by the GOLD guideline. However,

certain guidelines with a more narrow scope that answered a specific PIPOH also

scored high in quality; for example the British Thoracic society‘s guidelines on

pulmonary rehabilitation, home oxygen, or emergency oxygen.

The strengths of this report lie in its comprehensive search, and its dual independent

screening and quality assessment. Only guidelines published in English were

included, which presents a limitation.

References

1. The ADAPTE Collaboration. The ADAPTE Process: Resource Toolkit for Guideline

Adaptation. Version 2.0. 2009 [Available from: http://www.g-i-n.net].

2. Department of Health. The National Healthcare Quality Reporting System

Annual Report 2016 [Available from: http://health.gov.ie/patient-safety/national-

hospital-quality-reporting-system/.

3. The AGREE collaboration GW, Cluzeau FA, et al.,. Development and

validation of an international appraisal instrument for assessing the quality of clinical

practice guidelines: the AGREE project. Quality & safety in health care.

2003;12(1):18-23.

4. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global

Strategy for the Diagnosis, Management and Prevention of COPD. 2016. Available

from: http://goldcopd.org/.

5. Harrison MB, van den Hoek J. CAN‐IMPLEMENT©: A Guideline Adaptation and

Implementation Planning Resource. Kingston, Ontario, Canada: Canadian Guideline

Adaptation Study Group. Queen‘s University School of Nursing and Canadian

Partnership Against Cancer; 2010.

33

Appendix 1: Search strategy for guidelines for COPD management in adults

a. Databases searched

Main databases to be searched:

PubMed

Embase

CINAHL

DynaMed

b. Guideline internet sites and clearinghouses

Guideline Internet Sites URL

Department of Health (including National

Clinical Guidelines)

http://health.gov.ie

Health Service Executive (HSE) www.hse.ie

Health Information and Quality Authority (HIQA) www.hiqa.ie

National Institute for Health and Care

Excellence (NICE)

http://www.nice.org.uk/page.asp

x?o=ourguidance

Guidelines and Audit Implementation Network /

The Regulation and Quality Improvement

Authority

http://gain-

ni.org/index.php/audits/guidelines

NHS Evidence ( incorporating Scottish

Intercollegiate Guidelines Network (SIGN) &

Guidelines International Network (GIN))

www.evidence.nhs.uk

Institute for Clinical Systems Improvement (ICSI) http://www.icsi.org/knowledge

Food and Drug Administration http://www.fda.gov/cder/guidan

ce/index.htm

National Guidelines Clearinghouse (NGC) www.guideline.gov

New Zealand Guidelines Group http://www.nzgg.org.nz

National Health and Medical Research Council

(NHMRC) Australian Clinical Guidelines

www.clinicalguidelines.gov.au

Canadian Agency for Drugs and Technology in

Health

http://www.cadth.ca

Canadian Medical Association Infobase https://www.cma.ca/En/Pages/cli

nical-practice-guidelines.aspx

Haute utorite de ante (HAS) http://www.has-

sante.fr/portail/jcms/c_6056/fr/rec

herche-

avancee?portlet=c_39085&search

_antidot=&lang=en&typesf=guidel

ines

Ontario Guidelines Advisory Committee (GAC)

Recommended Clinical Practice Guidelines

http://www.gacguidelines.ca

Finnish Medical Society Duodecim http://www.kaypahoito.fi

World Health Organisation www.who.int

34

c. Professional bodies’ websites searched

Professional Bodies

Ireland

Irish Thoracic Society www.irishthoracicsociety.com

Respiratory Nurses Association of

Ireland

www.anail.ie

Royal College of Physicians Ireland www.rcpi.ie

Royal College of Surgeons Ireland www.rcsi.ie

Irish Medical Council www.medicalcouncil.ie

Irish College General Practitioners www.icgp.ie

Irish Society of Chartered

Physiotherapists

www.iscp.ie

Irish Nurses and Midwives

Organisation

www.inmo.ie

UK

British Thoracic Society www.brit-thoracic.org.uk

Scottish Thoracic Society https://sts.rcpe.ac.uk

Welsh Thoracic Society www.welshthoracicsociety.org.

uk

Royal College of Physicians London www.rcplondon.ac.uk

Association of Respiratory Nurse

Specialists (UK)

http://arns.co.uk

Europe

European Respiratory Society www.ersnet.org

European Respiratory Nurses

Association

www.erna.eu

Forum for European Respiratory

Societies

www.fersnet.org

European Society of Thoracic

Surgeons

www.ests.org

North

America

American Thoracic Society www.thoracic.org

American Association for Thoracic

Surgery

www.aats.org

American College of Chest

Physicians

www.chestnet.org

American Association for Respiratory

Care

www.aarc.org

California Thoracic Society https://03e5d8e.netsolhost.com

/CalThoracic

Oregon Thoracic Society http://action.lung.org/site/TR?fr

_id=13880&pg=entry

Canadian Thoracic Society www.respiratoryguidelines.ca

Registered Nurses Association of

Ontario

http://www.rnao.org

Australia &

Oceana

Thoracic Society of Australia and

New Zealand

www.thoracic.org.au

Asia

Hong Kong Thoracic Society http://hkresp.com/index.php/a

bout-joomla

Malaysian Thoracic Society www.mts.org.my/index.asp

Thoracic Society of Nepal http://thoracicsociety.org

Saudi Thoracic Society http://saudithoracic.com

35

Professional Bodies

Africa South African Thoracic Society www.pulmonology.co.za

Pan African Thoracic Society www.africanthoracic.org

Other

Forum of International Respiratory

Societies

www.firsnet.org

International Primary Care

Respiratory Group

www.theipcrg.org

Global Initiative for Chronic

Obstructive Lung Disease (GOLD)

http://new2.goldcopd.it

d. Google search

The first 10 pages of Google were searched.

e. Search terms used

Limits/filters:

- Date: past 10 years

- Language: English only

Field headings (eg. title, abstract, keyword) were used if deemed

appropriate.

Search Terms

Details Free Text Terms Thesauri Terms

Population: Adult

patients over 35 years of

age with a diagnosis of

COPD

COPD OR chronic obstructive

pulmonary disease OR COAD

OR chronic obstructive airway

disease OR chronic obstructive

lung disease OR chronic airflow

obstruction OR chronic airflow

obstructions

adult OR adults OR adulthood

MeSH: pulmonary

disease, chronic

obstructive

Emtree: chronic

obstructive lung disease

CINAHL: pulmonary

disease, chronic

obstructive

MeSH: adult (explode)

Emtree: adult (explode)

CINAHL: adult (explode)

Guidance

documentation

guideline OR guidelines OR

guidance OR policy OR policies

OR procedure OR procedures

OR protocol OR protocols OR

position statement OR position

statements OR consensus

statement OR consensus

statements OR practice

parameter OR practice

parameters OR best practice

OR best practices OR standard

OR standards OR CPG OR CPGs

OR pathway OR pathways OR

MeSH: Guideline

[Publication Type],

guidelines as topics,

Practice Guideline

[Publication Type], Health

Planning Guidelines

Emtree: practice

guideline (explode term)

CINAHL: practice

guidelines

36

path OR paths OR

recommendation OR

recommendations OR care

plan OR care plans OR good

clinical practice OR good

clinical practices OR map OR

maps OR algorithm OR

algorithms

37

Appendix 2: Documents that are not guidelines but may be of use to the GDG

Document Link

Commissioning toolkit for respiratory

services. Department of Health, UK.

2012.

https://www.gov.uk/government/publications/c

ommissioning-toolkit-for-respiratory-services

Clinical standards: chronic obstructive

pulmonary disease services. Healthcare

Improvement Scotland. 2010.

http://www.healthcareimprovementscotland.or

g/his/idoc.ashx?docid=514ce762-21ee-43f2-

b230-eb55028170e7&version=-1

An Outcomes Strategy for COPD and

Asthma: NHS Companion Document.

Department of Health, UK. 2012.

https://www.gov.uk/government/publications/a

n-outcomes-strategy-for-copd-and-asthma-nhs-

companion-document

Pantin CFA. BTS statement on criteria for

specialist referral, admission, discharge

and follow-up for adults with respiratory

disease. Thorax. 2008;63(SUPPL. 1):i1-i16.

(PDF attached)

Department of Social Protection.

Chronic Obstructive Pulmonary Disease.

2014.

http://www.welfare.ie/en/downloads/protocol1

3.pdf

Department of Health (UK) Consultation

on a Strategy for Services for Chronic

Obstructive Pulmonary Disease (COPD)

in England. 2010.

https://www.gov.uk/government/uploads/syste

m/uploads/attachment_data/file/213840/dh_11

3279.pdf

Health Quality Ontario. Chronic

Obstructive Pulmonary Disease (COPD)

Evidentiary Framework OHTAC COPD

Collaborative. 2012.

http://www.hqontario.ca/en/mas/tech/pdfs/20

12/rev_COPD_compendium_March2012.pdf

Government of Western Australia.

Chronic Obstructive Pulmonary Disease

Model of Care: Respiratory Health

Network. 2012.

http://www.healthnetworks.health.wa.gov.au/

modelsofcare/docs/Chronic_Obstructive_Pulmo

nary_Disease_Model_of_Care.pdf

Pulmonary Rehabilitation Model of

Care.

http://www.hse.ie/eng/health/hl/living/copd/Pu

lmonary_Rehabilitation_Model_of_Care_v_0_7.p

df

Health Information and Quality

Authority (HIQA) Health technology

assessment of chronic disease self-

management support interventions:

COPD (extracted from main report).

2015.

https://www.hiqa.ie/system/files/CDSM-

COPD.pdf

Technology Appraisal TA244:

Roflflumilast for the management of

severe chronic obstructive pulmonary

disease. 2012.

https://www.nice.org.uk/guidance/ta244/resour

ces/roflumilast-for-the-management-of-severe-

chronic-obstructive-pulmonary-disease-

82600431059653

Irish Thoracic Society. National

Respiratory (COPD) Framework. 2008.

http://www.irishthoracicsociety.com/images/up

loads/file/Draft_RespFramework_Oct_000.pdf

38

Appendix 3: AGREE II Quality assessment

No Guideline

(Most recent first)

AGREE II dimensions (Standardised domain scores: average percentage scores for each domain)

Scope

&

Purpose

(1)

Stakeholder

involvement

(2)

Rigour of

development

(3)

Clarity &

presentation

(4)

Applicability

(5)

Editorial

independence

(6)

Overall

assessment

(7)

Recommend?

1 Global Strategy for

Diagnosis,

Management, and

Prevention of COPD –

2017.

100 100 100 100 50 50 89.3 Yes

2 Hardinge M,

Annandale J, Bourne

S, Cooper B, Evans A,

Freeman D, et al.

British Thoracic

Society guidelines for

Home Oxygen use in

adults. Thorax.

2015;70:i1-i43.

100 100 100 100 65 100 92.3 Yes

Hardinge M,

Suntharalingam J,

Wilkinson T. Guideline

update: The British

Thoracic Society

Guidelines on home

oxygen use in adults.

Thorax.

2015;70(6):589-91.

3 AARC clinical

practice guideline:

effectiveness of

100 64 65 97 10 50 64.3 Yes with

modification

39

pharmacologic

airway clearance

therapies in

hospitalized patients.

American Association

for Respiratory Care.

2015.

4 Prevention of acute

exacerbations of

chronic obstructive

pulmonary disease:

American College of

Chest Physicians and

Canadian Thoracic

Society Guideline.

2015.

100 100 100 100 38 50 85.7 Yes

5 Clinical Practice

Guideline on Adult

Domiciliary Oxygen

Therapy: Executive

summary from the

Thoracic Society of

Australia and New

Zealand. 2016. (But

published as a report

in 2014)

100 33 100 100 13 50 75 Yes

6 British Thoracic

Society (BTS)

guideline on

pulmonary

rehabilitation in

adults: Accredited by

NICE. 2013.

100 100 100 100 52 50 92.9 Yes

40

7 Managing dyspnea

in patients with

advanced chronic

obstructive

pulmonary disease: A

Canadian Thoracic

Society clinical

practice guideline.

2011.

100 67 100 100 25 100 85.7 Yes

8 Diagnosis and

Management of

Stable Chronic

Obstructive

Pulmonary Disease: A

Clinical Practice

Guideline from the

American College of

Physicians, American

College of Chest

Physicians, American

Thoracic Society, and

European Respiratory

Society. 2011.

100 67 100 100 0 100 85.7 Yes

9 Department of

Veterans

Affairs/Department of

Defense (VA/DoD)

clinical practice

guideline on

management of

outpatient COPD.

2015.

100 100 99 100 60 100 85.7 Yes

41

Institute for Clinical

Systems Improvement

(ICSI); Chronic

Obstructive

Pulmonary Disease

(COPD), Diagnosis

and Management of.

2016.

Ontario Guidelines

Advisory Committee

(GAC)

Recommended

Clinical Practice

Guidelines. COPD:

Exacerbation.

Ontario Guidelines

Advisory Committee

(GAC)

Recommended

Clinical Practice

Guidelines. COPD:

Improving Survival.

Ontario Guidelines

Advisory Committee

(GAC)

Recommended

Clinical Practice

Guidelines. COPD

(Stable): Treatment.

42

10 Canadian Medical

Association Infobase,

Clinical practice

guidelines for the use

of noninvasive

positive-pressure

ventilation and

noninvasive

continuous positive

airway pressure in the

acute care setting.

2011.

100 61 100 100 27 100 85.7 Yes

11 McKim DA, Road J,

Avendano M, Abdool

S, Côté F, Duguid N,

et al. Home

mechanical

ventilation: A

Canadian Thoracic

Society clinical

practice guideline.

Canadian respiratory

journal.

2011;18(4):197-215.

100 89 100 100 0 100 85.7 Yes

12 CTS Guideline

Optimizing

pulmonary

rehabilitation in

chronic obstructive

pulmonary disease -

practical issues. 2010.

100 67 88 100 0 100 85.7 Yes

43

13 National Institute for

Health and Care

Excellence (NICE)

CG101: Chronic

obstructive

pulmonary disease in

over 16s: diagnosis

and management.

2010. (+2012

evidence update;

second link)

100 100 100 100 94 100 100 Yes

National Institute for

Health and Care

Excellence (NICE)

National costing

report: chronic

obstructive

pulmonary disease:

Implementing NICE

Guidance. 2011.

National Institute for

Health and Clinical

Excellence (NICE)

Evidence Update 5 –

Chronic obstructive

pulmonary disease.

February 2012.

Pathway: Chronic

obstructive

pulmonary disease.

Quality Standard

QS10: Chronic

44

obstructive

pulmonary disease in

adults (QS10). 2011.

(+ see more info in

second link)

14 Non-invasive

ventilation in chronic

obstructive

pulmonary disease.

Royal College of

Physicians of London

– RCP. 2008.

94 97 84 100 21 54 78.6 Yes

15 2008 Update CTS

Guideline - Highlights

for Primary Care -

Recommendations

for Management of

COPD. 100 50 100 100 25 100 75.0 Yes

2007 Update CTS

Guideline -

Recommendations

for Management of

COPD.

14 British Thoracic

Society (BTS)

guideline on

emergency oxygen

use in adult patients.

2008 + correction:

Thorax 2009

Jan;64(1):91.

Commentary

100 100 100 100 75 50 92.3 Yes

45

15 British Thoracic

Society. Intermediate

care—Hospital-at-

Home in chronic

obstructive

pulmonary disease:

British Thoracic

Society guideline.

2007.

100 64 80 100 60 0 85.7 Yes

46