scholarly journals A review of national guidelines for management of COPD in Europe

2016 ◽  
Vol 47 (2) ◽  
pp. 625-637 ◽  
Author(s):  
Marc Miravitlles ◽  
Claus Vogelmeier ◽  
Nicolas Roche ◽  
David Halpin ◽  
João Cardoso ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Treatment Goals ◽  
National Guidelines ◽  
Obstructive Pulmonary Disease ◽  
The Czech Republic ◽  
Criteria For Diagnosis ◽  
Long Acting

The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators.There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of long-acting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments.

scholarly journals Combination of ICSs and LABAs Should Be Used in the Management of Patients with COPD — The Con Argument

2004 ◽  
Vol 11 (3) ◽  
pp. 224-226
Author(s):  
Jeremy Road
Keyword(s):  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled ◽  
The Past ◽  
Related Quality ◽  
Health Related ◽  
Long Acting

The management of patients with symptomatic chronic obstructive pulmonary disease (COPD) has become more clear in the past several years. New medications have been developed and their efficacy has been evaluated using important outcomes in addition to forced expiratory volume in 1 s (FEV1), such as health-related quality of life (HRQL), frequency of exacerbations and dyspnea scores. I will review five welldesigned, randomized, controlled trials that have advanced our knowledge about the use of inhaled corticosteroids (ICSs), long-acting beta2-agonists (LABAs) and their combination.

scholarly journals Global initiative gold and national recommendations on the management of patients with chronic obstructive pulmonary disease (COPD): the place of double bronchodilation

2019 ◽  
pp. 17-21
Author(s):  
A. A. Vizel ◽  
I. Yu. Vizel
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Evidence Base ◽  
Chronic Obstructive ◽  
National Guidelines ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative ◽  
Long Acting ◽  
Real Practice

Chronic obstructive pulmonary disease (COPD) is a chronic, environmentally mediated disease manifested by broncho-obstructive syndrome, which is not completely reversible.The purpose of this review was to summarize the latest changes in the management of these patients, which occurred in international and domestic guidelines.Methods. The analysis of work on the problem of COPD, available in the E-Library and PubMed electronic libraries, was carried out.Results. The year 2019 was marked by the renewal of global GOLD initiatives and the implementation of national guidelines for the diagnosis and treatment of COPD in practice. The most significant provisions are the following: double long-acting bronchodilators are the main treatment for stable COPD; specific indications are needed for the administration of ICS and they are not universal in the treatment of COPD; not all double bronchodilators are the same – their evidence base is not yet equivalent. The analysis of real practice shows that the use of shortacting bronchodilators, ICS and triple therapy remains excessive.Conclusion. Understanding of COPD is improving, identifying the most vulnerable points, problems, the solution of which will make it possible to take new steps to improve the quality of life of these patients and reduce mortality. 

Current opportunities of inhaled corticosteroid therapy in patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 31 (1) ◽  
pp. 75-87
Author(s):  
I. V. Leshchenko ◽  
A. S. Meshcheryakova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Fixed Combination ◽  
Chronic Obstructive ◽  
Delivery Device ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Long Acting ◽  
Blood Eosinophils

Chronic obstructive pulmonary disease (COPD) is the leading cause of death in the structure of respiratory diseases. The problem of rational pharmacotherapy of COPD have attracted attention of the medical scientific society for many years. The understanding of the pathogenesis of the disease has deepened and approaches to the therapy have changed. Some COPD patients need regular fixed-combination therapy: long-acting bronchodilators (LABD) and inhaled corticosteroids (ICS) in order to prevent exacerbations and reduce the severity of symptoms of the disease. Blood eosinophils count is one of criteria for choosing regular therapy. The appearance of fixed triple combinations of ICS/LABD increased the effectiveness of COPD therapy, and a new delivery device for fixed combination of budesonide/formoterol makes it possible to use ICS successfully in the most severe patients.

Patterns of use and trends in the use of medications for the control of COPD in a cohort of Colombian patients, 2017-2019 v1

2021 ◽  
Author(s):  
Jorge Machado Alba
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Population Database ◽  
Obstructive Pulmonary Disease ◽  
Prescription Patterns ◽  
Short Acting ◽  
Patterns Of Use ◽  
Long Acting

Introduction: Chronic obstructive pulmonary disease (COPD) affects approximately 174 million people worldwide.The objective was to determine the trends of the use of medications for COPD in a group of Colombian patients. Methods: This was a retrospective study on prescription patterns of bronchodilators and other medications used in COPD from a population database with follow-up at 12 and 24 months. Patients older than 18 years of age of any sex who had COPD between 2017 and 2019 were included. Sociodemographic variables, medications, treatment schedules for COPD, comorbidities, comedications, and the specialty of the prescriber were considered. Results: A total of 9,476 people with a diagnosis of COPD were evaluated. They had a mean age of 75.9 ± 10.7 years, 50.1% were men, and 86.8% were prescribed by a general practitioner. At the beginning of the follow-up, on average, they received 1.6 medications/patient, mainly short-acting antimuscarinics (3784; 39.9%), followed by short-acting β-agonists (2997, 31.6%) and inhaled corticosteroids (ICS) (2239, 23.6%), but 5083 (53.6%) patients received a long-acting bronchodilator. At the beginning of the follow-up, 645 (6.8%) patients were put on triple therapy with antimuscarinics, β-agonists, and ICS, and at 12 months, this rose to 1388 (20.6%). A total of 57.9% had comorbidities, most often hypertension (44.4%). Conclusions: This group of patients with COPD treated in Colombia frequently received short-acting bronchodilators and ICS, but a growing proportion are undergoing controlled therapy with long-acting bronchodilators, a situation that can improve the indicators of morbidity, exacerbations, and hospitalization.

scholarly journals Chronic obstructive pulmonary disease in ambulatory practice

2008 ◽  
pp. 29-33
Author(s):  
N. M. Shmeleva ◽  
V. P. Sidorova ◽  
A. S. Belevsky ◽  
E. I. Shmelev
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Outpatient Clinic ◽  
Chronic Obstructive ◽  
National Guidelines ◽  
Obstructive Pulmonary Disease ◽  
Incorrect Diagnosis ◽  
Educational Programmes ◽  
Inadequate Therapy

Quality of outpatient management of patients with chronic obstructive pulmonary disease (COPD) and ways to improve it have been studied in this trial. The study included analysis of 560 medical recorders of outpatients followed up in one and the same outpatient clinic by one and the same physician for 5 to 10 yrs and who were currently newly diagnosed for COPD, epidemiological investigation using questionnaire and spirometry in all patients attending the outpatient clinic, and organization of educational COPD center for physicians, nurses and patients. We assessed concordance of the patients' management according to medical records to national guidelines. Most frequent discrepancies were inaccurate recording of the patient's symptoms and history, incomplete and inadequate examination, incorrect diagnosis, inadequate therapy. Functional disorders were not estimated in 95.9 % of the patients, COPD stage was not determined in 100 % of the cases, severity was not assessed in 83.9 %, and 70.7 % of the patients were not diagnosed for complications and exacerbations of the disease. Inhaled bronchodilators were not administered in 41.9 % of the patients, 90 % of the patients were inadequately treated with antibiotics, 100 % of the patients were not vaccinated. The main reasons for this mismatching were thought to be poor awareness of COPD by physicians, lack of pneumologists in outpatient clinics, and insufficient technical provision of the outpatients clinics with spirographs, oxymeters, etc. The epidemiological examination involved 8 672 patients, among them 38 % reported respiratory symptoms and 24 % had ventilatory disorders. COPD was firstly diagnosed in 768 patients. Implementation of educational programmes have led to necessary functional investigations to be used twice more frequent.

Diagnosis and management of COPD in primary care

2021 ◽  
Vol 14 (4) ◽  
pp. 350-355
Author(s):  
Katarzyna Mycroft ◽  
Katarzyna Górska
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Treatment Initiation ◽  
Disease Diagnosis ◽  
Chronic Obstructive ◽  
Disease Treatment ◽  
Obstructive Pulmonary Disease ◽  
Long Acting ◽  
Significant Health

Chronic obstructive pulmonary disease is a significant health problem. However, a large proportion of cases remain undiagnosed. Early diagnosis of chronic obstructive pulmonary disease leads to earlier treatment initiation, and in consequence, to improvement of patients quality of life. The gold standard for chronic obstructive pulmonary disease diagnosis is spirometry and the presence of irreversible obstruction after a bronchodilator. One of the most important interventions in the treatment of chronic obstructive pulmonary disease is anti-smoking education. The main group of drugs used in chronic obstructive pulmonary disease treatment are the long-acting bronchodilators.

Development of MDS-Based Predication Model for COPD Severity in Nursing Home Residents

2021 ◽  
pp. 106002802110592
Author(s):  
Barbara Blaylock ◽  
Xiaoli Niu ◽  
H. Edward Davidson ◽  
Stefan Gravenstein ◽  
Ronald DePue ◽  
...  
Keyword(s):  
Nursing Home ◽  
Treatment Guidelines ◽  
Cohort Analysis ◽  
Nursing Home Residents ◽  
Chronic Obstructive ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Treatment Pathways ◽  
Selection Of Variables ◽  
Long Acting

Background Assessing chronic obstructive pulmonary disease (COPD) severity is challenging in nursing home (NH) residents due to incomplete symptom assessments and exacerbation history. Objective The objective of this study was to predict COPD severity in NH residents using the Minimum Data Set (MDS), a clinical assessment of functional capabilities and health needs. Methods A cohort analysis of prospectively collected longitudinal data was conducted. Residents from geographically varied Medicare-certified NHs with age ≥60 years, COPD diagnosis, and ≥6 months NH residence at enrollment were included. Residents with severe cognitive impairment were excluded. Demographic characteristics, medical history, and MDS variables were extracted from medical records. The care provider–completed COPD Assessment Test (CAT) and COPD exacerbation history were used to categorize residents by Global Initiative for Chronic Lung Disease (GOLD) A to D groups. Multivariate multinomial logit models mapped the MDS to GOLD A to D groups with stepwise selection of variables. Results Nursing home residents (N = 175) were 64% women and had a mean age of 77.9 years. Among residents, GOLD B was most common (A = 13.1%; B = 44.0%; C = 5.7%; D = 37.1%). Any long-acting bronchodilator (LABD) use and any dyspnea were significant predictors of GOLD A to D groups. The predicted MDS-GOLD group (A = 6.9%; B = 52.6%; C = 4.6%; D = 36.0%) showed good model fit (correctly predicted = 60.6%). Nursing home residents may underuse group-recommended LABD treatment (no LABD: B = 53.2%; C = 80.0%; D = 40.0%). Conclusion and Relevance The MDS, completed routinely for US NH residents, could potentially be used to estimate COPD severity. Predicted COPD severity with additional validation could provide a map to evidence-based treatment guidelines and may help to individualize treatment pathways for NH residents.

scholarly journals Maintained therapeutic effect of revefenacin over 52 weeks in moderate to very severe Chronic Obstructive Pulmonary Disease (COPD)

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
James F. Donohue ◽  
Edward Kerwin ◽  
Sanjay Sethi ◽  
Brett Haumann ◽  
Srikanth Pendyala ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Outcomes ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Open Label ◽  
Double Blind ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Abstract Background Revefenacin is a long-acting muscarinic antagonist that was recently approved for the nebulized treatment of chronic obstructive pulmonary disease (COPD). Although shorter duration studies have documented the efficacy of revefenacin in COPD, longer-term efficacy has not been described. In a recent 52-week safety trial, revefenacin was well tolerated and had a favorable benefit-risk profile. Here we report exploratory efficacy and health outcomes in patients receiving revefenacin 175 μg or 88 μg daily during the 52-week trial. Methods In this randomized, parallel-group, 52-week trial (NCT02518139), 1055 participants with moderate to very severe COPD received revefenacin 175 μg or 88 μg in a double-blind manner, or open-label active control tiotropium. Results Over the 52-week treatment period, both doses of revefenacin, as well as tiotropium, elicited significant (all p < 0.0003) improvements from baseline in trough forced expiratory volume in 1 s (FEV1). The trough FEV1 profile (least squares mean change from baseline) for revefenacin 175 μg ranged from 52.3–124.3 mL and the trough FEV1 profile for tiotropium ranged from 79.7–112.8 mL. In subgroup comparisons, the effect of revefenacin on trough FEV1 was comparable in patients taking concomitant long-acting β-agonists, with or without inhaled corticosteroids, with patients who were not taking these medications. There were statistically significant (p < 0.05) improvements in all measured health status outcomes (evaluated using St. George’s Respiratory Questionnaire, COPD Assessment Test, Clinical COPD Questionnaire and Baseline and Transition Dyspnea Index) from 3 months onward, in all treatment arms. Conclusions Significant sustained improvements from baseline in trough FEV1 and respiratory health outcomes were demonstrated for 175-μg revefenacin over 52 weeks, further supporting its use as a once-daily bronchodilator for the nebulized treatment of patients with COPD. Trial registration NCT02518139; Registered 5 August 2015.

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