ALAT-2014 Chronic Obstructive Pulmonary Disease (COPD) Clinical Practice Guidelines: questions and answers

Arch Bronconeumol. 2015 Aug;51(8):403-16. doi: 10.1016/j.arbres.2014.11.017. Epub 2015 Jan 14.
[Article in English, Spanish]


ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.

Keywords: Chronic obstructive pulmonary disease (COPD); Clinical practice guideline; Enfermedad pulmonar obstructiva crónica (EPOC); Guía de práctica clínica.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-2 Receptor Agonists / therapeutic use
  • Antibiotic Prophylaxis
  • Bronchodilator Agents / therapeutic use
  • Drug Therapy, Combination
  • Environmental Exposure
  • Epidemiologic Studies
  • Evidence-Based Medicine
  • Female
  • Humans
  • Male
  • Mass Screening
  • Muscarinic Antagonists / therapeutic use
  • Opportunistic Infections / prevention & control
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Sex Distribution
  • Smoking / adverse effects
  • Vaccination


  • Adrenal Cortex Hormones
  • Adrenergic beta-2 Receptor Agonists
  • Bronchodilator Agents
  • Muscarinic Antagonists