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 In people who have chronic obstructive pulmonary disease, some drug treatments prevent flare-ups

Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest. 2015;147:894-942.

Review question

In people who have chronic obstructive pulmonary disease (COPD), which treatments are recommended to prevent flare-ups (sudden worsening, also referred to as“exacerbations”)?


COPD is a lung disease that impairs breathing. Smoking is often the cause. Infections—colds, bronchitis or pneumonia—often cause breathing to worsen.

Many types of treatments have been used to prevent acute worsening of COPD.

How the review was done

The researchers did a systematic review based on studies available up to April 2013.

They found many studies, including randomized controlled trials, 8 guidelines, and 53 systematic reviews.

Key features of the studies were:

  • people were > 40 years of age, had COPD, and were current or previous smokers;
  • treatments included nondrug treatments (including vaccines, smoking cessation, pulmonary rehabilitation, and education), inhaled treatments (“puffers,” including long-acting beta2-agonists [LABAs], long-acting muscarinic antagonists [LAMAs], short-acting muscarinic antagonists [SAMAs], inhaled corticosteroids [ICSs]), and pills (including systemic corticosteroids, statins, theophylline); and
  • treatments were compared with other treatments or placebo.

What the researchers found

Compared with placebo, risk or frequency of flare-ups was reduced by:

  • annual influenza vaccination;
  • LABAs;
  • LAMAs; and
  • a combination of ICSs and LABAs.

Compared with SAMAs, LAMAs reduced flare-ups.

Compared with ICSs alone, a combination of ICSs and LABAs reduced flare-ups.


In people who have COPD, influenza vaccination, LABAs, LAMAs, and ICSs plus LABAs prevent flare-ups.

Treatments for preventing acute flare-ups in people with chronic obstructive pulmonary disease*




Influenza vaccination


Annual influenza vaccination reduces the number of flare-ups a person might have.



In people with moderate to severe COPD, LABAs reduce the risk of moderate and severe flare-ups.



In people with moderate to severe COPD, LAMAs reduce risk of flare-ups.


SAMA (ipratropium)

LAMAs (tiotropium) prevent flare-ups.

Combination ICS/LABA


In people with moderate to very severe COPD, a combination of ICSs plus LABAs reduces risk of flare-ups.


ICSs alone

In people with moderate to very severe COPD, a combination of ICSs plus LABAs reduces risk of flare-ups.

*ICS = inhaled corticosteroid; LABA = long-acting beta2-agonist; LAMA = long-acting muscarinic antagonist; SAMA = short-acting muscarinic antagonist.

Related Topics


A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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