Priority 4 from the COPD Exacerbation PSP

UNCERTAINTY: What is the optimal combination of treatments at COPD exacerbations and what is the best way to decide this for individual patients? (JLA PSP Priority 4)
Overall ranking	4
JLA question ID	0104/4
Explanatory note	Most exacerbations are treated with a combination of 'bronchodilator' drugs to help make breathing easier and anti-inflammatory 'steroids', with or without antibiotics. This treats all exacerbations as similar yet there is evidence that exacerbations differ. This question addresses how best to know which combination of treatments are best for which exacerbation. Doing so would make sure people get the treatments they need, whilst avoiding unnecessary side-effects (and the cost of) treatments not likely to help.
Evidence	This question is an area of uncertainty.
Health Research Classification System category	Respiratory

Extra information provided by this PSP
Original uncertainty examples	I often have flare ups of COPD and need to take time off work. How can I manage these flare ups? I am a smoker. ~ Could there be a treatment carried by paramedics to administer to prevent hospital admissions. ~ What is the impact of all the usual exacerbation treatments on duration of exacerbation?~ How often do exacerbations improve on usual therapy without any additional? ~ Should a patient stop as soon as they feel better or follow traditional advice to complete the course?~ Best way to self-treat when you get one! ~ What can relatives do to treat or ease exacerbations?
Submitted by	Patient, Carer, Relative, Healthcare professional

Extra information provided by this PSP

Original uncertainty examples

I often have flare ups of COPD and need to take time off work. How can I manage these flare ups? I am a smoker. ~ Could there be a treatment carried by paramedics to administer to prevent hospital admissions. ~ What is the impact of all the usual exacerbation treatments on duration of exacerbation?~ How often do exacerbations improve on usual therapy without any additional? ~ Should a patient stop as soon as they feel better or follow traditional advice to complete the course?~ Best way to self-treat when you get one! ~ What can relatives do to treat or ease exacerbations?

Submitted by

Patient, Carer, Relative, Healthcare professional

PSP information
PSP unique ID	0104
PSP name	COPD Exacerbation PSP
Total number of uncertainties identified by this PSP.	51 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	1 April 2021