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Chronic obstructive pulmonary disease - Management
Basis for recommendation
These recommendations are based on the National Institute for Health and Clinical Excellence (NICE) guideline Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update) [National Clinical Guideline Centre, 2010; NICE, 2010].
- NICE reviewed evidence from one randomized controlled trial and two controlled studies without randomization, which found benefits from long-term oxygen therapy for people with cor pulmonale.
- NICE found insufficient evidence to recommend changing the current clinical practice of using diuretics to control peripheral oedema in people with cor pulmonale.
- CKS found no published evidence to indicate appropriate starting or maximum dosages of diuretics. The recommended starting dosage, titration, and monitoring are based on expert opinion from CKS reviewers.
- NICE reviewed the evidence for other treatments (angiotensin-converting enzyme inhibitors, calcium-channel blockers, alpha-blockers, and digoxin); studies either had methodological limitations or found no benefit in symptoms of COPD or cor pulmonale from active treatment.
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