scholarly journals Present and Prospective Therapeutic Regimens for COPD

2012 ◽  
Vol 4 ◽  
pp. CMT.S2106
Author(s):  
Teresa A. Schweiger
Keyword(s):  
Combination Therapy ◽  
Patient Outcomes ◽  
Treatment Guidelines ◽  
Chronic Obstructive ◽  
Anticholinergic Agent ◽  
Obstructive Pulmonary Disease ◽  
Prevalent Disease ◽  
Appropriate Therapy ◽  
Long Acting ◽  
General Step

Chronic Obstructive Pulmonary Disease is a prevalent disease throughout the world. Recently updated treatment guidelines were published and still endorse a general step-wise approach to therapy based on severity of disease. The heterogeneity of the disease makes it difficult to determine appropriate therapy based on the data available. Currently, combination therapy, specifically triple therapy with a long acting beta2 agonist, a long acting anticholinergic agent, and an inhaled corticosteroid appear to achieve the best patient outcomes. In addition, there is a desperate need for new therapy with a different mechanism of action than those already on the market. The recommendations concerning stable COPD treatment will be reviewed, as well as, efficacy data regarding combination therapy. In addition, a few new and prospective therapies will be evaluated.

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 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 Comparison of Effectiveness Using Different Dual Broncho- dilator Agents in Chronic Obstructive Pulmonary Disease Treatment

2020 ◽  
Author(s):  
Shih-Lung Cheng
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lung Function ◽  
Combination Therapy ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Dose Combination ◽  
Long Acting

Abstract BackgroundThe efficacy and safety of fixed dual long-acting bronchodilators for chronic obstruction pulmonary disease (COPD) patients has been well established; however, there is a paucity of clinical effectiveness comparison in patients with COPD treatment. The aim of the current study was to compare the efficacy of three once daily dual bronchodilator agents in patients with COPD.MethodsPatients with diagnosed COPD and treated with a long-acting beta agonist (LABA) + long-acting muscarinic antagonist (LAMA) fixed-dose combination therapy (UME/VIL [umeclidinium and vilanterol inhalation powder], IND/GLY [indacaterol and glycopyrronium], and TIO/OLO [tiotoprium and olodaterol]) were enrolled in this retrospective study over a period of 12 months. Effectiveness assessments were evaluated using a COPD assessment test (CAT) and lung function parameters. Besides, times for acute exacerbation were also assessed.ResultsThe enrolled patients’ number was 77 in IND/GLY, 76 in UME/VIL and 83 in TIO/OLO. Lung function measurements with FEV1 had significantly improved for patients using TIO/OLO (98.7 ml) compared to those of IND/GLY (65.2 ml) and UMEC/VIL (64.4 ml) (p<0.001). CAT scores were also significantly decreased in patients treated with TIO/OLO (CAT down 5.6) than those with IND/GLY (3.8) and UMEC/VIL (3.9) (p=0.03). Acute exacerbation was also reduced in patients using TIO/OLO (4.8%) compared with those using IND/GLY (10.4%) and UMEC/VIL (10.5%) (p=0.01).ConclusionSignificant improvement in pulmonary function, symptoms were demonstrated after 12 months of LABA+LAMA fixed-dose combination therapy with 3 different treatment options. TIO/OLO demonstrated higher therapeutic effects compared with UME/VIL or IND/GLY. Determining clinical relevance will require a well-designed randomized controlled trial.Key Words: Chronic obstructive pulmonary disease (COPD), dual bronchodilator, LABA/LAMA

scholarly journals Comparison of Effectiveness Using Different Dual Bronchodilator Agents in Chronic Obstructive Pulmonary Disease Treatment

2021 ◽  
Vol 10 (12) ◽  
pp. 2649
Author(s):  
Shih-Lung Cheng
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lung Function ◽  
Combination Therapy ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Bronchodilator Agents ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Dose Combination ◽  
Long Acting

The effectiveness and safety of fixed dual long-acting bronchodilators for chronic obstructive pulmonary disease (COPD) patients have been well established; however, there is a paucity of clinical effectiveness comparison in patients with COPD treatment. The aim of the current study was to compare the effectiveness of three once-daily dual bronchodilator agents in patients with COPD. Patients with diagnosed COPD and treated with a long-acting beta-agonist (LABA) + long-acting muscarinic antagonist (LAMA) fixed-dose combination therapy (UME/VIL (umeclidinium and vilanterol inhalation powder), IND/GLY (indacaterol and glycopyrronium), and TIO/OLO (tiotropium and olodaterol)) were enrolled in this retrospective study over a period of 12 months. Effectiveness assessments were evaluated using a COPD assessment test (CAT) and lung function parameters. Besides, times for acute exacerbation were also assessed. The enrolled patients’ number was 177 in IND/GLY, 176 in UME/VIL and 183 in TIO/OLO. Lung function measurements with FEV1 had significantly improved for patients using TIO/OLO (98.7 mL) compared to those of IND/GLY (65.2 mL) and UME/VIL (64.4 mL) (p < 0.001). CAT scores were also significantly decreased in patients treated with TIO/OLO (CAT down 5.6) than those with IND/GLY (3.8) and UME/VIL (3.9) (p = 0.03). Acute exacerbation was also reduced in patients using TIO/OLO (4.9%) compared with those using IND/GLY (10.2%) and UME/VIL (11.9%) (p = 0.01). Significant improvement in pulmonary function, symptoms were demonstrated after 12 months of LABA/LAMA fixed-dose combination therapy with three different treatment options. TIO/OLO demonstrated higher therapeutic effects compared with UME/VIL or IND/GLY. Determining clinical relevance will require a well-designed randomized controlled trial.

Role of Long-Acting Muscarinic Antagonist/Long-Acting β2-Agonist Therapy in Chronic Obstructive Pulmonary Disease

2017 ◽  
Vol 51 (8) ◽  
pp. 696-705 ◽  
Author(s):  
Sarah E. Petite
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Combination Therapy ◽  
Maintenance Therapy ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Muscarinic Antagonist ◽  
Randomized Controlled ◽  
Long Acting ◽  
Copd Maintenance

Objective: To compare the available literature regarding the use of long-acting muscarinic antagonist (LAMA)/long-acting β2 agonists (LABA) and inhaled corticosteroid (ICS)/LABA combination inhaler therapy in chronic obstructive pulmonary disease (COPD) maintenance therapy management. Data Sources: A MEDLINE literature search from database inception to February 2017 was conducted using the search terms chronic obstructive pulmonary disease, adrenergic beta-agonist, muscarinic antagonist, and inhaled corticosteroid. References from extracted sources were further searched for any relevant, missed data sources. Study Selection and Data Extraction: All English-language randomized-controlled trials comparing LAMA/LABA and ICS/LABA combination inhaler therapy were evaluated. Data Synthesis: A total of 10 randomized controlled trials have reviewed the use of LAMA/LABA compared with ICS/LABA therapy for COPD maintenance therapy. Results of clinical trials that evaluated LAMA/LABA and ICS/LABA maintenance therapy demonstrated superior improvements in pulmonary function tests via spirometry and improved clinical outcomes with LAMA/LABA therapy, specifically reduction in COPD exacerbation rates. The safety of LAMA/LABA combination therapy also is favorable compared with ICS/LABA combination therapy because of the increased infection risk with ICS therapy. Conclusions: COPD is a disease state with significant morbidity and mortality in the United States and is the third leading cause of death. Long-acting inhalers are recommended for the majority of COPD severities, and combination therapy is typically utilized. LAMA/LABA combination therapy has demonstrated superior improvements in pulmonary function and reduction in COPD exacerbation rates compared with ICS/LABA. LAMA/LABA combination therapy will have a larger future role in COPD maintenance management.

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