Prehospital treatment modalities for acute exacerbation of chronic obstructive pulmonary disease: a scoping review

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a frequent reason for emergency calls and carries substantial short- and long-term mortality. Prehospital management is widely used but variably supported by evidence. To systematically identify and map prehospital interventions for AECOPD and describe the breadth and characteristics of the existing evidence, with the aim of informing future research priorities and prehospital care planning. PubMed and Embase were searched through January 2025 following PRISMA-ScR standards. Two reviewers independently screened and charted studies, with third-reviewer consensus. Eligible studies addressed prehospital interventions for confirmed or suspected AECOPD. No formal quality appraisal was performed. The protocol was preregistered on OSF (https://doi.org/10.17605/OSF.IO/CZNG8). Among 2,591 records, 34 studies were included (28 primary and 6 secondary). Most primary evidence was observational, and only about two-thirds of studies enrolled confirmed AECOPD populations. Controlled oxygen therapy (n = 8) was associated with lower observed mortality and fewer adverse physiological outcomes compared with liberal oxygen delivery, informed by one cluster randomized trial and several observational studies. CPAP (n = 7) and NIV (n = 7) consistently improved short-term physiological parameters. Randomized evidence for patient-centered outcomes remains limited, as all CPAP/NIV trials were small, enrolled mixed respiratory failure populations, or both. Evidence for dexamethasone, air-driven nebulizers, point-of-care ultrasound, and hyperoxemia harms was sparse and largely observational. Controlled oxygen therapy has the largest prehospital evidence base, and titrated oxygen targeting SpO₂ 88–92% is associated with more favorable physiological profiles and lower observed mortality than liberal oxygen delivery, although certainty is limited without formal quality appraisal. CPAP and NIV improve short-term physiology, but effects on patient-centered outcomes remain uncertain. Evidence for other interventions is minimal, and substantial knowledge gaps remain.