scholarly journals The use of short-acting bronchodilators in patients with chronic bronchoobstructive pathology at the present stage

2021 ◽  
pp. 91-99
Author(s):  
K. A. Zykov ◽  
V. V. Vikentyev ◽  
I. V. Goloborodova ◽  
I. I. Kopchenov ◽  
O. V. Bondarec ◽  
...  
Keyword(s):  
Real Life ◽  
Drug Regimen ◽  
Point Of View ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Short Acting ◽  
Beta Agonists ◽  
Metered Dose ◽  
Long Time ◽  
Long Acting

Inhaled short-acting bronchodilators (beta-agonists and M-anticholinergics) have been used for a long time in patients with bronchoobstructive diseases, the main representatives of which are chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). Given the fact that most patients with COPD and BA are treated with long-acting bronchodilators, the question arises about the place of short-acting drugs in modern treatment algorithms for bronchoobstructive pathology. The data on how many patients take short-acting beta-agonists and M- anticholinergics in real-life clinical practice, and how appropriate it is to use these drugs on top of prolonged drugs are provided. The Russian part of the international POPE-study analyzed the characteristics of outpatients with COPD. It was found that the vast majority of patients have short-acting bronchodilators as part of their therapy, and more than 50% of patients receive a combination of SABA and SAAC, and in most cases this is represented by a combination of fenoterol + ipratropium. Taking into account that the majority of patients with COPD and asthma receive prolonged bronchodilators, important from a practical point of view is the question of the effectiveness of short-acting drugs on the background of prolonged ones. The article discusses these aspects of therapy and provides evidence that the use of SABA and SAAC provides an opportunity to achieve additional bronchodilatation when used against the background of prolonged bronchodilators. Thus, symptomatic use of SABA and SAAC on demand in bronchoobstructive pathology have sufficient justification even in the presence of a combination of prolonged bronchodilators in patient therapy. At the same time, it is necessary to take into account the increased probability of side effects with such drug regimen. The article also discusses the issues of different types of inhalation devices for short-acting bronchodilators (nebulizers and metered-dose aerosol inhalers), provides data on their comparative effectiveness and safety. 

scholarly journals Pharmacotherapies for COPD

2013 ◽  
Vol 7 ◽  
pp. CCRPM.S7211 ◽  
Author(s):  
Stan Ejiofor ◽  
Alice M. Turner
Keyword(s):  
Inhaled Corticosteroids ◽  
Review Article ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Short Acting ◽  
Beta Agonists ◽  
Drug Classes ◽  
Pde Inhibitors ◽  
Clinical Trial Results ◽  
Long Acting

This review article summarizes the main treatments for chronic obstructive pulmonary disease, their mechanisms, and the key evidence from trials supporting their use. Drug classes covered were short acting beta agonists (SABA), short acting muscarinic antagonists (SAMA), long acting beta agonists (LABA), long acting antimuscarinics (LAMA), inhaled corticosteroids (ICS), LABA/ ICS combinations, specific phosphodiesterase (PDE4) inhibitors, non-specific PDE inhibitors, mucolytics, and oxygen. Non-specific therapies, such as opiates for relief of dyspnoea and therapies for smoking cessation, are also covered briefly. For each class of drug, mechanisms of action are described, key clinical trial results are reported, and available agents compared. Finally, the place of each drug in therapy is compared between current worldwide guidelines.

scholarly journals Implementation of guideline-based therapy for chronic obstructive pulmonary disease: Differences between men and women veterans

2017 ◽  
Vol 14 (4) ◽  
pp. 385-391 ◽  
Author(s):  
Seppo T Rinne ◽  
A Rani Elwy ◽  
Chuan-Fen Liu ◽  
Renda Soylemez Wiener ◽  
Lisa Thayer ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Muscarinic Antagonists ◽  
Obstructive Pulmonary Disease ◽  
Men And Women ◽  
Short Acting ◽  
Beta Agonists ◽  
Long Acting ◽  
Va Hospitals

Chronic obstructive pulmonary disease (COPD) is common among both men and women, and guidelines recommend the same therapy for both sexes. While previous studies have identified gender differences in other chronic disease management, few studies have examined how implementation of COPD guidelines differs between men and women. We performed a cross-sectional study of veterans admitted to Veterans Affairs (VA) hospitals for COPD during October 1, 2008, to September 30, 2011. We collected information on baseline COPD medications during the 6 months prior to hospitalization and categorized therapies as “appropriate” or “inappropriate” based on current guidelines. We used multivariable logistic regression to examine the differences in COPD medications between men and women, after controlling for baseline patient characteristics. We also examined the differences in hospital outcomes, including length of stay and hospital readmission. We identified 33,558 veterans, including 1149 women and 32,409 men who were admitted to 130 VA hospitals. Women were significantly less likely to have received inhaler therapies prior to admission, with lower rates of short-acting beta agonists, short-acting muscarinic antagonists, long-acting beta agonists, and long-acting muscarinic antagonists compared to men. Women also received fewer appropriate inhaler combinations (odds ratio [OR] = 0.83, 95% confidence interval [CI] 0.74–0.93) and more inappropriate combinations (OR = 1.33, 95% CI 1.17–1.51). Women and men were prescribed similar rates of inhaled steroid and oral steroids. Hospital outcomes were also similar between the two groups. These findings highlight a potential gender disparity in appropriate outpatient COPD therapy. Improving the quality of care for patients with COPD should include equitable implementation of guideline-based COPD management.

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 Use of inhaled devices during a hospital exacerbation of COPD: a summary of an interdisciplinary audit held at ICS Maugeri Pavia, Italy (March-June 2019)

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Michele Vitacca ◽  
Cinzia Lastoria ◽  
Monica Delmastro ◽  
Domenico Fiorenza ◽  
Pasquale De Cata ◽  
...  
Keyword(s):  
Treatment Algorithm ◽  
Real Life ◽  
Inhalation Therapy ◽  
Chronic Obstructive ◽  
Patient Needs ◽  
Treatment Protocols ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Long Acting ◽  
Exacerbation Of Copd

To date treatment protocols in Respiratory and or Internal departments across Italy for treatment of chronic obstructive pulmonary disease (COPD) patients at hospital admission with relapse due to exacerbation do not find adequate support in current guidelines. Here we describe the results of a recent clinical audit, including a systematic review of practices reported in literature and an open discussion comparing these to current real-life procedures. The process was dived into two 8-hour-audits 3 months apart in order to allow work on the field in between meeting and involved 13 participants (3 nurses, 1 physiotherapist, 2 internists and 7 pulmonologists). This document reports the opinions of the experts and their consensus, leading to a bundle of multidisciplinary statements on the use of inhaled drugs for hospitalized COPD patients. Recommendations and topics addressed include: i) monitoring and diagnosis during the first 24 h after admission; ii) treatment algorithm and options (i.e., short and long acting bronchodilators); iii) bronchodilator dosages when switching device or using spacer; iv) flow measurement systems for shifting to LABA+LAMA within 48 h; v) when nebulizers are recommended; vi) use of SMI to deliver LABA+LAMA when patient needs SABA <3 times/day independently from flow limitation; vii) use of DPI and pre-dosed MDI to deliver LABA+LAMA or TRIPLE when patient needs SABA <3 times/day, with inspiratory flow > 30 litres/min; viii) contraindication to use DPI; ix) continuation of LABA-LAMA when patient is already on therapy; x) possible LABA-LAMA dosage increase; xi) use of SABA and/or SAMA in addition to LABA+LABA; xii) use of SABA+SAMA restricted to real need; xiii) reconciliation of drugs in presence of comorbidities; xiv) check of knowledge and skills on inhalation therapy; xv) discharge bundle; xvi) use of MDI and SMI in tracheostomized patients in spontaneous and ventilated breathing.

scholarly journals Pharmacotherapy of Chronic Obstructive Pulmonary Disease: A Clinical Review

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Balazs Antus
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Phosphodiesterase Inhibitor ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Mortality And Morbidity ◽  
Short Acting ◽  
Significant Burden ◽  
Long Acting

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide. In addition to generating high healthcare costs, COPD imposes a significant burden in terms of disability and impaired quality of life. Unlike many leading causes of death and disability, COPD is projected to increase in many regions of the world as the frequency of smoking is rising and the population is aging. The pharmacological treatment of COPD includes bronchodilators to relax smooth muscle, such as β2-agonists (salbutamol, terbutaline, and fenoterol, short-acting β2-agonists as well as salmeterol, formoterol, and indacaterol, and long-acting β2-agonists) and anticholinergics, such as ipratropium, oxitropium (short-acting anticholinergic), and tiotropium (long-acting anticholinergic). Although airway inflammation in COPD poorly responds to steroids, several inhaled corticosteroids (fluticasone, budesonide, and beclomethasone) are in use in combination with long-acting β2-agonists. Other medications include theophylline (both a bronchodilator and a phosphodiesterase inhibitor) and the phosphodiesterase-4 antagonists, such as roflumilast. Finally, a number of novel long-acting anticholinergics and β2-agonists with once- or twice-daily profiles are in development and clinical testing.

Real-Life Clinical and Functional Effects of Fluticasone Furoate/Umeclidinium/Vilanterol-Combined Triple Therapy in Patients with Chronic Obstructive Pulmonary Disease

Respiration ◽  
2020 ◽  
pp. 1-8
Author(s):  
Corrado Pelaia ◽  
Giada Procopio ◽  
Maria Rosaria Deodato ◽  
Olivia Florio ◽  
Angelantonio Maglio ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Triple Therapy ◽  
Real Life ◽  
Chronic Obstructive ◽  
Fluticasone Furoate ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Copd Patients ◽  
Inhaled Therapy ◽  
Long Acting

<b><i>Background:</i></b> Triple therapy consisting of a drug association including an inhaled corticosteroid, a long-acting muscarinic receptor antagonist and a long-acting β<sub>2</sub>-adrenergic agonist, delivered via a single device, can be a valuable treatment for chronic obstructive pulmonary disease (COPD) patients experiencing frequent disease exacerbations. <b><i>Objectives:</i></b> The aim of this real-life, single-center, observational study was to evaluate, in 44 COPD patients with recurrent exacerbations, the effects of the triple inhaled therapy combining fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI). <b><i>Methods:</i></b> Within such a therapeutic context, several clinical and lung functional parameters were considered at baseline and after 24 weeks of treatment with combined inhaled triple therapy. <b><i>Results:</i></b> With respect to baseline, after 24 weeks of treatment with FF/UMEC/VI, significant changes were recorded with regard to Modified British Medical Research Council (<i>p</i> &#x3c; 0.0001) and COPD Assessment Test (<i>p</i> &#x3c; 0.0001) scores, COPD exacerbations (<i>p</i> &#x3c; 0.001), forced expiratory volume in the first second (<i>p</i> &#x3c; 0.001), residual volume (<i>p</i> &#x3c; 0.01), forced mid-expiratory flow between 25 and 75% of FVC (<i>p</i> &#x3c; 0.0001), inspiratory capacity (<i>p</i> &#x3c; 0.01), forced vital capacity (<i>p</i> &#x3c; 0.05), and peak expiratory flow (<i>p</i> &#x3c; 0.0001). Moreover, in a subgroup of 28 patients, a significant increase of diffusion lung capacity (<i>p</i> &#x3c; 0.01) was also detected. <b><i>Conclusions:</i></b> In conclusion, our real-life results suggest that triple inhaled therapy with FF/UMEC/VI, when given to COPD patients with frequent exacerbations, is able to positively impact on dyspnea and global health status as well as to significantly decrease COPD exacerbations and improve airflow limitation and lung hyperinflation.

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