Question 25

Could you discuss the role of guidelines in managing AECOPD?

Despite concerns that guidelines may have introduced a form of “cookbook” medicine, I have found that they help physicians make rapid therapeutic decisions based on evidence-based medicine. They allow physicians to tailor treatment to the specific patient being treated and the local resistance patterns. It is also useful for clinicians to use spirometry results in conjunction with guidelines to help decide on the most appropriate treatment of AECOPD. It is now recognized that, as lung function diminishes, reflected in a drop in forced expiratory volume in one second (FEV₁) below 50%, there is a greater probability of the infection being caused by a Gram-negative, particularly H. influenzae and then P. aeruginosa. Therefore, in this subgroup of patients, an antibacterial agent such as levofloxacin with activity against these two pathogens would be a useful treatment.
The GOLD 2009 guidelines (15) recommend appropriate antibiotics based on local susceptibility data. That is why these Asia-Pacific Advisory Board (APAB) results are so important as they indicate new trends in terms of likely ABECOPD pathogens and their antibacterial susceptibility. The recent GOLD guidelines reported that based on current evidence, antibiotics should be given to the following patients: