scholarly journals Pro/Con: A unified conclusion-Inhaled corticosteroids for chronic obstructive pulmonary disease

2019 ◽  
Vol 2 (1) ◽  
pp. 46-47
Author(s):  
Margaret F. Ragland ◽  
Donald A. Mahler ◽  
Barry J. Make
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Con A ◽  
Obstructive Pulmonary Disease ◽  
Long Acting ◽  
The Right

ICS are like any other drug: they have benefits and they have risks.6,7 In the right patient, often the patient with frequent exacerbations and severe uncontrolled symptoms, an inhaler regimen, including dual long-acting bronchodilators and an ICS may be the right choice. For the patient with infrequent exacerbations, low symptom burden, and recent pneumonia that caused hospitalization, an inhaler regimen that contains an ICS may bring more risk than benefit. In addition, analysis of recent data, including the WISDOM8 trial, has provided evidence that ICS may be most beneficial in the immediate postexacerbation period. Further, ICS may be safely discontinued in patients with few exacerbations and stable symptoms.9 As with any long-term medication, a nuanced risk-benefit calculation by the prescribing physician and informed discussion with the patient are ultimately the best ways to balance the use of ICS that have benefits in some patients and risks in others.

Promoting Primary Palliative Care in Severe Chronic Obstructive Pulmonary Disease: Symptom Management and Preparedness Planning

2018 ◽  
Vol 34 (2) ◽  
pp. 85-91 ◽  
Author(s):  
Aziz A. Ansari ◽  
Daniel H. Pomerantz ◽  
Robert L. Jayes ◽  
Eric A. Aguirre ◽  
Rachel D. Havyer
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
Symptom Management ◽  
Inhaled Corticosteroids ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Preparedness Planning ◽  
Long Acting

Chronic obstructive pulmonary disease (COPD) poses challenges not only in symptom management but also in prognostication. Managing COPD requires clinicians to be proficient in the primary palliative care skills of symptom management and communication focused on eliciting goals and preferences. Dyspnea should initially be managed with the combination of long-acting muscarinic antagonists and long-acting β-agonist inhalers, adding inhaled corticosteroids if symptoms persist. Opioids for the relief of dyspnea are safe when used at appropriate doses. Oxygen is only effective for relieving dyspnea in patients with severe hypoxemia. The relapsing-remitting nature of COPD makes prognostication challenging; however, there are tools to guide clinicians and patients in making plans both with respect to prognosis and symptom burden. Preparedness planning techniques promote detailed culturally appropriate conversations which allow patients and clinicians to consider disease-specific complications and develop goal-concordant treatment plans.

scholarly journals Differential treatment strategy in patients with different clinical phenotypes of chronic obstructive pulmonary disease

2013 ◽  
Vol 94 (5) ◽  
pp. 610-614
Author(s):  
E A Lapteva
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Treatment Strategy ◽  
Inhaled Corticosteroids ◽  
Control Treatment ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Clinical Phenotypes ◽  
Long Acting

Aim. To optimize the treatment in patients with chronic obstructive pulmonary disease in primary care. Methods. The effectiveness of different strategies of long-term control treatment in 245 patients with chronic obstructive pulmonary disease depending on clinical phenotypes of the disease was evaluated. Three groups of patients were formed: patients from the 1 st group (70 patients, 33 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) were using long-acting anticholinergics, patients from the 2 nd group (110 patients, 52 - with predominant emphysema phenotype, 58 - with predominant bronchitis phenotype) - long-acting anticholinergics and inhaled corticosteroids, and patients from the 3 rd group (65 patients, 28 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) - long-acting anticholinergics together with inhaled corticosteroids and long-acting beta 2-agonists. The respiratory function, diffusing lung capacity and gas exchange parameters were assessed after 12 months of long-term control treatment. Results. The 2nd treatment strategy was more effective in patients with bronchitis phenotype, confirmed by the increase of forced expiratory volume at 1st second (FEV 1) value from 1.12±1.04 to 1.90±1.05 (р 0.05), and partial oxygen pressure (р аО 2) increase from 53.72±6.28 to 69.56±6.83 mmHg, as well as partial carbon dioxide pressure (р аCО 2) decrease from 55.71±8.34 to 52.34±8.16 mmHg. No significant changes in patients with emphysema phenotype were observed. The treatment strategy 3 was the most effective in patients with emphysema phenotype which was demonstrated by the increase of FEV 1 from 1.18±0.03 to 1.47±0.03, р аО 2 from 66.43±3.79 to 78.48±5.78 mmHg (р 0.05), diffusion capacity of carbon monoxide to alveolar volume ratio (DLCO/Va) increase from 35.32±11.34 to 44.12±12.2 (р 0.05) and decrease of р аО 2 from 50.21±3.68 to 43.43±5.47 mmHg. No significant improvement of gas exchange parameters in patients with bronchitis phenotype was registered. The treatment strategy 1 had no significant effect on respiratory function parameters. Conclusion. The differential strategies of long-term control treatment should be used depending on clinical phenotypes to optimize the treatment of chronic obstructive pulmonary disease.

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.

scholarly journals Prognostic and Functional Impact of Perioperative LAＭA/LABA Inhaled Therapy In Patients With Lung Cancer and Chronic Obstructive Pulmonary Disease 

2021 ◽  
Author(s):  
Yoko Azuma ◽  
Atsushi Sano ◽  
Takashi Sakai ◽  
Satoshi Koezuka ◽  
Hajime Otsuka ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Postoperative Complications ◽  
Lung Function ◽  
Pulmonary Disease ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Abstract Background: Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. The utility of several perioperative bronchodilators in patients with COPD requiring surgery for lung cancer has been reported, but the most suitable agent and its specific effect on postoperative long-term prognosis remain unclear. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.Methods: Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical records. Patients were divided into 3 groups according to perioperative management: LAMA/LABA (n=64), LAMA (n=23) and rehabilitation only (no bronchodilator) (n=43). Results: Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p<0.001 for both forced expiratory volume in 1 second (FEV1) and percentage of predicted forced expiratory volume in 1 second (FEV1 %pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, 223.1 mL vs 130.0 mL, ΔFEV1 %pred, 10.8% vs 6.8%; both p<0.05). There was a trend toward a lower incidence of postoperative complications in the LAMA/LABA group compared with the LAMA and rehabilitation-only groups. In patients with moderate to severe air flow limitation (n=61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with patients in the other groups. Perioperative LAMA/LABA therapy was also associated with lower recurrence rates. Conclusions: Patients who receive perioperative LAMA/LABA for moderate to severe COPD have improved prognosis and better pulmonary function with surgery for lung cancer. We believe this treatment combination is optimal for patients with lung cancer and COPD.

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.

Sign in / Sign up

Export Citation Format

Share Document