![]() ![]() The target values are PaO 2 ≥60 mm Hg or SpO 2 ≥90%. Antitussives are contraindicated.Ĥ) Vitamin D supplementation is used only in patients with documented deficiency (blood vitamin D concentration 55%. Antioxidants and respiratory stimulants are not recommended. In patients with moderate to severe COPD, ≥2 exacerbations in the last 2 years, and not treated with ICS, the use of carbocysteine or N-acetylcysteine may reduce the frequency of exacerbations. Do not use roflumilast in patients who are underweight or treated with theophylline.ġ) In young patients with confirmed alpha 1-antitrypsin deficiency, consider alpha 1-antitrypsin augmentation therapy.Ģ) Morphine to control dyspnea in patients receiving palliative care (see Dyspnea in Palliative and End-of-Life Care).ģ) Mucolytics: Avoid routine long-term use (except in selected patients with viscous bronchial secretions). Roflumilast is a phosphodiesterase-4 ( PDE-4) inhibitor it may be considered as an add-on therapy (500 mg once daily) to 1 or 2 inhaled bronchodilators in group C or D patients with symptoms of chronic bronchitis. The relative benefit of those drugs over 2-inhaler regimen and relative value against each other is not proven or not clear.Ģ) LAMA-containing inhalers may have an advantage over those without LAMA for preventing COPD exacerbations.ģ) Combination therapies are likely more effective than monotherapies for improving symptom and quality-of-life scores.Ĥ) ICS-containing inhalers are associated with an increased risk of pneumonia.Ĥ. Several products contain LAMA and LABA in a single inhaler (aclidinium/formoterol, glycopyrronium/indacaterol, tiotropium/olodaterol, umeclidinium/vilanterol). The relevant points are:ġ) The LABA/ LAMA combination is likely the most effective for reducing COPD exacerbations in populations at risk for exacerbation with the additive effect on bronchodilation and lung function. Dual combination therapy versus long-acting bronchodilators alone for chronic obstructive pulmonary disease (COPD): a systematic review and network meta-analysis. ![]() ![]() Quality of Evidence lowered due to imprecision.Oba Y, Keeney E, Ghatehorde N, Dias S. Evidence 5 Moderate Quality of Evidence (moderate confidence that we know true effects of the intervention). Combination of inhalers from different classes: Numerous studies comparing effects of drugs from different classes are available and were recently summarized in a Cochrane network meta-analysis. ICSs increase the risk of pneumonia, oral candidiasis, hoarse voice, and skin bruising.ģ. The modified Medical Research Council ( mMRC) dyspnea scale (available at ) is also a possibility but limited to the assessment of dyspnea (see Dyspnea).Ģ) Worsening of spirometric parameters of airflow limitation (based on FEV 1).ģ) Risk of exacerbations estimated on the basis of:Ī) The number and severity of exacerbations in the prior 12 months (1 exacerbation per year. The clinical COPD questionnaire ( CCQ) (available at ccq.nl) is another option. Evaluation of peripheral eosinophil count may also be of value in guiding therapy for potential underlying eosinophilic bronchitis and recurrent exacerbation.Ģ) Electrocardiography ( ECG), echocardiography: Features of cor pulmonale.ģ) Tests for alpha 1-antitrypsin deficiencyin patients 20 correspond to very severe symptoms. A rare (55%) in patients with hypoxemia or normocytic normochromic anemia (anemia of chronic disease). Often the prevalence of COPD is closely associated with the prevalence of tobacco smoking, although in many countries occupational and indoor air pollution are major additional risk factors. PMID: 30521694 PMCID: PMC6517098.Īccording to the 2022 Global Initiative for Chronic Obstructive Lung Disease ( GOLD) guideline, chronic obstructive pulmonary disease ( COPD) is defined as “a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases,” with the overall severity of disease increased by exacerbations and comorbidities. Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD – 2019 update on evidence. PMID: 32283960 PMCID: PMC7193862.īourbeau J, Bhutani M, Hernandez P, et al. An Official American Thoracic Society Clinical Practice Guideline. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease (2021 report). Global Initiative for Chronic Obstructive Lung Disease.
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