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.

Inhaled therapy for chronic obstructive pulmonary disease

2021 ◽  
Vol 32 (Sup10) ◽  
pp. S15-S22
Author(s):  
Andrew Booth
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Inhaled Steroids ◽  
Flu Vaccination ◽  
Inhaled Therapy ◽  
Long Acting ◽  
Careful Assessment

Chronic obstructive pulmonary disease is characterised by progressive symptoms of productive cough, breathlessness, wheeze and exacerbations. Airway obstruction is detected by quality assured spirometry, and is defined as a Forced Expired Volume in one second / Forced Vital Capacity ratio <0.7. Inhaled therapy is the most effective treatment solution, with bronchodilators and inhaled steroids helping to improve symptoms, quality of life and lung function, while reducing risk of exacerbations. Bronchodilators are available as both monotherapy and as dual combination therapy. Inhaled steroids can be added to inhaled long-acting bronchodilators, but are not without significant complications, including pneumonia. Therefore, careful assessment of the phenotype of a patient with chronic obstructive pulmonary disease must be given before commencing any therapy that contains inhaled steroid and other treatments, such as flu vaccination, smoking cessation and pulmonary rehabilitation should be given due consideration.

Early bronchodilatory response to the first dose of indacaterol/glycopyrronium as an additional individual predictor of their effectiveness in the treatment of chronic obstructive pulmonary disease

2020 ◽  
Vol 22 (4) ◽  
pp. 17-22
Author(s):  
N. V. Sharova ◽  
S. L. Grishaev ◽  
D. V. Cherkashin ◽  
S. V. Efimov ◽  
M. A. Kharitonov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Signs ◽  
Chronic Obstructive ◽  
Shortness Of Breath ◽  
Obstructive Pulmonary Disease ◽  
Long Acting ◽  
The Impact

The effectiveness of the early bronchodilatory response of the first dose of a fixed double combination of long-acting bronchodilators of various classes indacaterol/glycopyrronium and long-acting anticholinergics glycopyrronium and Tiotropium in patients suffering from stable chronic obstructive pulmonary disease is compared. It was found that in all patients included in the study and suffering from chronic obstructive pulmonary disease, changes in functional respiratory indicators were accompanied by positive and comparable dynamics of clinical signs: a decrease in the severity of shortness of breath, the impact of the disease on the quality of life and increased tolerance to physical activity. It was found that the combination of indacaterol/glycopyrronium provides rapid, pronounced and prolonged bronchodilation in patients suffering from chronic obstructive pulmonary disease compared to the separate use of glycopyrronium and Tiotropium. Consistent use of glycopyrronium and salbutamol leads to maximum bronchodilation, which makes it advisable to separate the use of prolonged bronchodilators when initiating therapy for chronic obstructive pulmonary disease. Therefore, there is a clinical feasibility of taking not only fixed combinations of bronchodilators of different classes, but also their consistent use. The results of an early bronchodilatory response to the first dose of indacaterol/glycopyrronium can be used as an additional individual predictor of their effectiveness in the treatment of chronic obstructive pulmonary disease.

Inhaled therapy for chronic obstructive pulmonary disease

2020 ◽  
Vol 2 (9) ◽  
pp. 486-494
Author(s):  
Andrew Booth
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Inhaled Steroids ◽  
Flu Vaccination ◽  
Inhaled Therapy ◽  
Long Acting ◽  
Careful Assessment

Chronic obstructive pulmonary disease is characterised by progressive symptoms of productive cough, breathlessness, wheeze and exacerbations. Airway obstruction is detected by quality assured spirometry, and is defined as a Forced Expired Volume in one second / Forced Vital Capacity ratio <0.7. Inhaled therapy is the most effective treatment solution, with bronchodilators and inhaled steroids helping to improve symptoms, quality of life and lung function, while reducing risk of exacerbations. Bronchodilators are available as both monotherapy and as dual combination therapy. Inhaled steroids can be added to inhaled long-acting bronchodilators, but are not without significant complications, including pneumonia. Therefore, careful assessment of the phenotype of a patient with chronic obstructive pulmonary disease must be given before commencing any therapy that contains inhaled steroid and other treatments, such as flu vaccination, smoking cessation and pulmonary rehabilitation should be given due consideration.

scholarly journals Risk of cardiovascular events after initiation of long-acting bronchodilators in patients with chronic obstructive lung disease: A population-based study

2016 ◽  
Vol 4 ◽  
pp. 205031211667133 ◽  
Author(s):  
Almotasembellah Aljaafareh ◽  
Jose Ruben Valle ◽  
Yu-Li Lin ◽  
Yong-Fang Kuo ◽  
Gulshan Sharma
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Obstructive Pulmonary Disease ◽  
Emergency Department ◽  
Treatment Group ◽  
Confidence Interval ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Disease Treatment ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Objectives: Long-acting bronchodilators are mainstay treatment for moderate to severe chronic obstructive pulmonary disease. A growing body of evidence indicates an increased risk of cardiovascular events upon initiation of these medications. We hypothesize that this risk is higher in patients with chronic obstructive pulmonary disease who had a preexisting cardiovascular disease regardless of receipt of any cardiovascular medication. Methods: A retrospective cohort of patients with a diagnosis of chronic obstructive pulmonary disease based on two outpatient visits or one inpatient visit for chronic obstructive pulmonary disease (International Classification of Diseases, 9th Edition, Clinical Modification codes 491.x, 492.x, 496) in any year between 2001 and 2012 from a commercial insurance database. We then selected those initiating long-acting bronchodilator treatments between April 2001 and September 2012. Each patient had a 1 year look back period to determine history of cardiovascular disease or cardiovascular disease treatment from the time of first prescription of long-acting beta agonist, long-acting muscarinic antagonist, or long-acting beta agonist combined with inhaled corticosteroids. Patients were followed for 90 days for hospitalizations or emergency department visits for cardiovascular event. The cohort was divided into four groups based on the presence of cardiovascular disease (including ischemic heart disease, hypertension, ischemic stroke, heart failure, tachyarrhythmias and artery disease based on International Classification of Diseases, 9th Edition, Clinical Modification codes) and cardiovascular disease treatment defined as acetylsalicylic acid, beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, antiplatelet, anticoagulants, calcium channel blockers, nitrate, digoxin, diuretics, antiarrhythmics or statins. Odds of emergency department visit or hospitalization in the 90 days after prescription were examined using multivariable logistic regression models. Results: Of 61,651 eligible patients, 36,755 (59.6%) had cardiovascular disease and were on cardiovascular disease treatment (Group 1), 7250 (11.8%) had cardiovascular disease without cardiovascular disease treatment (Group 2), 4715 (7.7%) had no cardiovascular disease but had cardiovascular disease treatment (Group 3) and 12,931 (21%) had no cardiovascular disease and no treatment (Group 4). In these four groups, the unadjusted risk of emergency department visit or hospitalization for cardiovascular disease within 90 days of initiation was 5.45%, 2.95%, 1.55% and 0.96%, respectively. In multivariable analysis, the adjusted odds ratio with 95% confidence interval of emergency department visit/hospitalization for each of the first three groups to those with no cardiovascular disease and no treatment were 3.50 (95% confidence interval, 2.89–4.24), 2.15 (95% confidence interval, 1.71–2.70) and 1.36 (95% confidence interval, 1.01–1.82), respectively. Conclusion: The risk of cardiovascular events after initiation of long-acting bronchodilators is highest in patients with baseline cardiovascular disease and on cardiovascular disease medications. Clinicians should be cautious while prescribing these medications in patients with preexisting cardiovascular disease.

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. 

Tiotropium: A Bronchodilator for Chronic Obstructive Pulmonary Disease

2005 ◽  
Vol 39 (9) ◽  
pp. 1467-1475 ◽  
Author(s):  
Heather Somand ◽  
Tami L Remington
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Data Extraction ◽  
Tiotropium Bromide ◽  
Chronic Obstructive ◽  
Anticholinergic Agent ◽  
Obstructive Pulmonary Disease ◽  
Study Selection ◽  
Long Acting

OBJECTIVE: To review the scientific literature evaluating the efficacy and tolerability of tiotropium bromide, a new bronchodilator indicated for treatment of chronic obstructive pulmonary disease (COPD). DATA SOURCES: Articles were identified through searches of MEDLINE (1966–January 2005) using the key words tiotropium, BA 679 BR, chronic obstructive pulmonary disease, and anticholinergic agents. Additional citations were identified from bibliographies of publications cited. STUDY SELECTION AND DATA EXTRACTION: Experimental and observational studies of tiotropium bromide were selected. Trials of the efficacy of the drug in humans were the focus of the review. DATA SYNTHESIS: Tiotropium bromide is an effective bronchodilator for patients with COPD. It produces clinically important improvements in lung function, symptoms of dyspnea, quality of life, and exacerbation rates compared with placebo. In comparative studies, tiotropium does not appear to be more efficacious than salmeterol or ipratropium. CONCLUSIONS: Tiotropium is an effective inhaled anticholinergic agent that is recommended among preferred long-acting bronchodilators for the chronic management of moderate to very severe COPD. Although similar to ipratropium in efficacy and tolerability, it has the advantage of once-daily dosing.

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