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Bakeer M, Funk GC, Valipour A. Chronic obstructive pulmonary disease phenotypes: imprint on pharmacological and non-pharmacological therapy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1472. [PMID: 33313217 PMCID: PMC7723612 DOI: 10.21037/atm-20-2219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease associated with significant morbidity and mortality. Over the past few years, there has been cumulating interest in describing this heterogeneity and using this information to group patients into different COPD phenotypes. The term phenotype is defined as single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes. It describes also the physical appearance or biochemical characteristics which result from the genotype-environment interaction. Furthermore, it clearly identifies subgroups with a significant impact in the prognosis. Recently, approaches to COPD phenotyping have been significantly enhanced in tandem with developments in understanding the disease’s various pathological, clinical and genetic features. This knowledge inspired the researchers to investigate more tailored therapeutic strategies that could not only give a more potent effect but also help to avoid the traditional therapy’s undesirable side effects. Eventually, it could be said that the phenotypic approach to COPD in the last decade had a huge impact on daily practice and management delivered to COPD patients. In this review, we highlight the impact of pharmacological and non-pharmacological treatment options on COPD outcomes, using a personalized treatment strategy based on different phenotypes.
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Affiliation(s)
- Mostafa Bakeer
- Chest Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
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2
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Boixeda R, Díez-Manglano J, Gómez-Antúnez M, López-García F, Recio J, Almagro P. Consensus for managing patients with chronic obstructive pulmonary disease according to the CODEX index. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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3
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Boixeda R, Díez-Manglano J, Gómez-Antúnez M, López-García F, Recio J, Almagro P. Consensus for managing patients with chronic obstructive pulmonary disease according to the CODEX index. Rev Clin Esp 2019; 219:494-504. [PMID: 31030885 DOI: 10.1016/j.rce.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 10/26/2022]
Abstract
The comorbidity, obstruction, dyspnoea, exacerbations (CODEX) index is the first multicomponent scale designed to predict the risk of readmissions and mortality at 1 year for patients hospitalised for chronic obstructive pulmonary disease (COPD). The index includes the comorbidities (C) (measured by the Charlson index), the degree of obstruction (O) (assessed by the forced expiratory volume in 1 second percentage), dyspnoea (D) (stratified according to the modified Medical Research Council scale) and exacerbations (EX) in the previous year. Our objective was to prepare recommendations based on the index's various components for personalised therapeutic management. To this end, we performed a literature search based on guidelines, consensuses and systematic reviews, as a basis for preparing recommendations on basic concepts, comorbidities, dyspnoea, pulmonary obstruction, exacerbations and follow-up. The recommendations were then subjected to an external assessment process by a multidisciplinary group of 62 experts. In total, 108 recommendations were created, 96 of which achieved consensus, including the recommendation that COPD be considered a high-risk cardiovascular disease, as well as several specific recommendations on managing the various comorbidities. A consensus was reached on the recommended treatments in the guidelines for the various levels of obstruction, dyspnoea and exacerbations, adapted to the CODEX scores. Advice is also offered for patient follow-up after hospital discharge, which includes aspects on assessment, treatment and care coordination.
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Affiliation(s)
- R Boixeda
- Servicio de Medicina Interna, Hospital de Mataró, Mataró, Barcelona, España
| | - J Díez-Manglano
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Gómez-Antúnez
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F López-García
- Servicio de Medicina Interna, Hospital General de Elche, Elche, Alicante, España
| | - J Recio
- Servicio de Medicina Interna, Hospital Vall d'Hebron, Barcelona, España
| | - P Almagro
- Unidad de paciente crónico complejo, Servicio de Medicina Interna, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
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Petta V, Perlikos F, Loukides S, Bakakos P, Chalkias A, Iacovidou N, Xanthos T, Tsekoura D, Hillas G. Therapeutic effects of the combination of inhaled beta2-agonists and beta-blockers in COPD patients with cardiovascular disease. Heart Fail Rev 2018; 22:753-763. [PMID: 28840400 DOI: 10.1007/s10741-017-9646-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health problem worldwide, with co-morbidities contributing to the overall severity and mortality of the disease. The incidence and prevalence of cardiovascular disease among COPD patients are high. Both disorders often co-exist, mainly due to smoking, but they also share common underlying risk factors, such as aging and low-grade systemic inflammation. The therapeutic approach is based on agents, whose pharmacological properties are completely opposed. Beta2-agonists remain the cornerstone of COPD treatment due to their limited cardiac adverse effects. On the other hand, beta-blockers are administered in COPD patients with cardiovascular disease, but despite their proven cardiac benefits, they remain underused. There is still a trend among physicians over underprescription of these drugs in patients with heart failure and COPD due to bronchoconstriction. Therefore, cardioselective beta-blockers are preferred, and recent meta-analyses have shown reduced rates in mortality and exacerbations in COPD patients treated with beta-blockers.
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Affiliation(s)
- Vasiliki Petta
- Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Athens, Greece.
| | - Fotis Perlikos
- Pulmonary Division, Department of Critical Care, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Department of Respiratory Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, Athens, Greece
| | - Petros Bakakos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria University Hospital, Athens, Greece
| | - Athanasios Chalkias
- Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
- Department of Neonatology, National and Kapodistrian University of Athens, Medical School, Aretaieio University Hospital, Athens, Greece
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
- European University Cyprus, School of Medicine, Nicosia, Cyprus
| | - Dorothea Tsekoura
- Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Aretaieio University Hospital, Athens, Greece
| | - Georgios Hillas
- Pulmonary Division, Department of Critical Care, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
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5
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Tratamiento de la EPOC Estable. Arch Bronconeumol 2017. [DOI: 10.1016/s0300-2896(17)30361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA, Trigueros JA, Cosío BG, Casanova C, Riesco JA, Simonet P, Rigau D, Soriano JB, Ancochea J. Spanish COPD Guidelines (GesEPOC) 2017. Pharmacological Treatment of Stable Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.arbr.2017.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA, Trigueros JA, Cosío BG, Casanova C, Antonio Riesco J, Simonet P, Rigau D, Soriano JB, Ancochea J. Spanish Guidelines for Management of Chronic Obstructive Pulmonary Disease (GesEPOC) 2017. Pharmacological Treatment of Stable Phase. Arch Bronconeumol 2017; 53:324-335. [PMID: 28477954 DOI: 10.1016/j.arbres.2017.03.018] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 01/04/2023]
Abstract
The clinical presentation of chronic obstructive pulmonary disease (COPD) varies widely, so treatment must be tailored according to the level of risk and phenotype. In 2012, the Spanish COPD Guidelines (GesEPOC) first established pharmacological treatment regimens based on clinical phenotypes. These regimens were subsequently adopted by other national guidelines, and since then, have been backed up by new evidence. In this 2017 update, the original severity classification has been replaced by a much simpler risk classification (low or high risk), on the basis of lung function, dyspnea grade, and history of exacerbations, while determination of clinical phenotype is recommended only in high-risk patients. The same clinical phenotypes have been maintained: non-exacerbator, asthma-COPD overlap (ACO), exacerbator with emphysema, and exacerbator with bronchitis. Pharmacological treatment of COPD is based on bronchodilators, the only treatment recommended in low-risk patients. High-risk patients will receive different drugs in addition to bronchodilators, depending on their clinical phenotype. GesEPOC reflects a more individualized approach to COPD treatment, according to patient clinical characteristics and level of risk or complexity.
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Affiliation(s)
- Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España.
| | | | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, España
| | - Pere Almagro
- Servicio de Medicina Interna, Hospital Universitario Mutua de Terrassa, Terrassa, España
| | | | | | - Borja G Cosío
- Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Ciro Casanova
- Servicio de Neumología-Unidad de Investigación, Hospital Universitario La Candelaria, Tenerife, España
| | | | - Pere Simonet
- Centro de Salud Viladecans-2, Dirección Atención Primaria Costa de Ponent-Institut Català de la Salut, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de La Princesa (IISP), Universidad Autónoma de Madrid, Consultor Metodológico y de Investigación de SEPAR, Madrid, España
| | - Julio Ancochea
- Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación, Hospital Universitario de La Princesa (IISP), Universidad Autónoma de Madrid, Madrid, España
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Agustí A, Calverley PM, Decramer M, Stockley RA, Wedzicha JA. Prevention of Exacerbations in Chronic Obstructive Pulmonary Disease: Knowns and Unknowns. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2014; 1:166-184. [PMID: 28848819 DOI: 10.15326/jcopdf.1.2.2014.0134] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The 2011 recommendations of the Global initiative for chronic Obstructive Lung Disease (GOLD) constituted a major paradigm shift in COPD management since they set 2 major goals for the assessment and management of patients: (1) the reduction of their current level of symptoms (i.e., treat the patient today); and (2) the reduction of their risk of exacerbations (i.e., prevent them tomorrow). Exacerbations are not only an important clinical endpoint in patients with COPD, but they are also a risk factor themselves for additional adverse outcomes since they have been shown to increase the risk for mortality, to accelerate the decline in pulmonary function, and to decrease health status and quality of life. Despite their importance, many unanswered questions related to exacerbations remain. The purpose of this review is to discuss: (1)knowns and unknowns in our current understanding of exacerbations, (2) what known factors increase their risk, and (3) how to best prevent them.
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Affiliation(s)
- Alvar Agustí
- Institut del Tòrax, Hospital Clínic, Barcelona, Spain
| | - Peter M Calverley
- Clinical Sciences Center, University Hospital Aintree, Liverpool, United Kingdom
| | - Marc Decramer
- Respiratory Division, University Hospitals, Leuven, Belgium
| | - Robert A Stockley
- Lung Investigation Unit, University Hospitals of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jadwiga A Wedzicha
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, United Kingdom
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Dual bronchodilation for the treatment of chronic obstructive pulmonary disease: a review of the latest clinical data. ACTA ACUST UNITED AC 2014. [DOI: 10.4155/cli.14.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bateman ED, Mahler DA, Vogelmeier CF, Wedzicha JA, Patalano F, Banerji D. Recent advances in COPD disease management with fixed-dose long-acting combination therapies. Expert Rev Respir Med 2014; 8:357-79. [PMID: 24802656 DOI: 10.1586/17476348.2014.910457] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Combinations of two long-acting bronchodilators and long-acting bronchodilators with inhaled corticosteroids (ICS) are recommended therapies in the management of chronic obstructive pulmonary disease (COPD). Three fixed-dose combination products have recently been approved for the treatment of COPD (the long-acting β2-agonist plus long-acting muscarinic antagonist [LABA/LAMA] combinations glycopyrronium/indacaterol [QVA149] and umeclidinium/vilanterol, and the LABA/ICS fluticasone furoate/vilanterol), with others currently in late-stage development. LABA/LAMA and LABA/ICS combination therapies demonstrate positive effects on both lung function and patient-reported outcomes, with significant improvements observed with LABA/LAMA combinations compared with placebo, each component alone and other comparators in current use. No new safety concerns have been observed with combinations of long-acting bronchodilators. Combinations of two long-acting bronchodilators represent a new and convenient treatment option in COPD. This review summarizes published efficacy and safety data from clinical trials of both LABA/LAMA and novel LABA/ICS combinations in patients with COPD.
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Affiliation(s)
- Eric D Bateman
- Department of Medicine, Division of Pulmonology, University of Cape Town, George Street, Mowbray 7700, Cape Town, South Africa
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Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a respiratory disease that causes progressive symptoms of breathlessness, cough and mucus build-up. It is the fourth or fifth most common cause of death worldwide and is associated with significant healthcare costs.Inhaled long-acting beta2-agonists (LABAs) are widely prescribed to manage the symptoms of COPD when short-acting agents alone are no longer sufficient. Twice-daily treatment with an inhaled LABA is aimed at relieving symptoms, improving exercise tolerance and quality of life, slowing decline and even improving lung function and preventing and treating exacerbations. OBJECTIVES To assess the effects of twice-daily long-acting beta2-agonists compared with placebo for patients with COPD on the basis of clinically important endpoints, primarily quality of life and COPD exacerbations. SEARCH METHODS We searched the Cochrane Airways Group trials register, ClinicalTrials.gov and manufacturers' websites in June 2013. SELECTION CRITERIA Parallel, randomised controlled trials (RCTs) recruiting populations of patients with chronic obstructive pulmonary disease. Studies were required to be at least 12 weeks in duration and designed to assess the safety and efficacy of a long-acting beta2-agonist against placebo. DATA COLLECTION AND ANALYSIS Data and characteristics were extracted independently by two review authors, and each study was assessed for potential sources of bias. Data for all outcomes were pooled and subgrouped by LABA agent (formoterol 12 μg, formoterol 24 μg and salmeterol 50 μg) and then were separately analysed by LABA agent and subgrouped by trial duration. Sensitivity analyses were conducted for the proportion of participants taking inhaled corticosteroids and for studies with high or uneven rates of attrition. MAIN RESULTS Twenty-six RCTs met the inclusion criteria, randomly assigning 14,939 people with COPD to receive twice-daily LABA or placebo. Study duration ranged from three months to three years; the median duration was six months. Participants were more often male with moderate to severe symptoms at randomisation; mean forced expiratory volume in 1 second (FEV1) was between 33% and 55% predicted normal in the studies, and mean St George's Respiratory Questionnaire score (SGRQ) ranged from 44 to 55 when reported.Moderate-quality evidence showed that LABA treatment improved quality of life on the SGRQ (mean difference (MD) -2.32, 95% confidence interval (CI) -3.09 to -1.54; I(2) = 50%; 17 trials including 11,397 people) and reduced the number of exacerbations requiring hospitalisation (odds ratio (OR) 0.73, 95% CI 0.56 to 0.95; I(2) = 10%; seven trials including 3804 people). In absolute terms, 18 fewer people per 1000 were hospitalised as the result of an exacerbation while receiving LABA therapy over a weighted mean of 7 months (95% CI 3 to 31 fewer). Scores were also improved on the Chronic Respiratory Disease Questionnaire (CRQ), and more people receiving LABA treatment showed clinically important improvement of at least four points on the SGRQ.The number of people who had exacerbations requiring a course of oral steroids or antibiotics was also lower among those taking LABA (52 fewer per 1000 treated over 8 months; 95% CI 24 to 78 fewer, moderate quality evidence).Mortality was low, and combined findings of all studies showed that LABA therapy did not significantly affect mortality (OR 0.90, 95% CI 0.75 to 1.08; I(2) = 21%; 23 trials including 14,079 people, moderate quality evidence). LABA therapy did not affect the rate of serious adverse events (OR 0.97, 95% CI 0.83 to 1.14; I(2) = 34%, moderate quality evidence), although there was significant unexplained heterogeneity, especially between the two formoterol doses.LABA therapy improved predose FEV1 by 73 mL more than placebo (95% CI 48 to 98; I(2) = 71%, low quality evidence), and people were more likely to withdraw from placebo than from LABA therapy (OR 0.74, 95% CI 0.69 to 0.80; I(2) = 0%). Higher rates of withdrawal in the placebo arm may reduce our confidence in some results, but the disparity is more likely to reduce the magnitude of difference between LABA and placebo than inflate the true effect; removing studies at highest risk of bias on the basis of high and unbalanced attrition did not change conclusions for the primary outcomes. AUTHORS' CONCLUSIONS Moderate-quality evidence from 26 studies showed that inhaled long-acting beta2-agonists are effective over the medium and long term for patients with moderate to severe COPD. Their use is associated with improved quality of life and reduced exacerbations, including those requiring hospitalisation. Overall, findings showed that inhaled LABAs did not significantly reduce mortality or serious adverse events.
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Affiliation(s)
- Kayleigh M Kew
- Population Health Sciences and Education, St George's, University of London, Cranmer Terrace, London, UK, SW17 0RE
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13
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Louie S, Zeki AA, Schivo M, Chan AL, Yoneda KY, Avdalovic M, Morrissey BM, Albertson TE. The asthma-chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations. Expert Rev Clin Pharmacol 2013; 6:197-219. [PMID: 23473596 PMCID: PMC7046086 DOI: 10.1586/ecp.13.2] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a commonly encountered yet loosely defined clinical entity. ACOS accounts for approximately 15-25% of the obstructive airway diseases and patients experience worse outcomes compared with asthma or COPD alone. Patients with ACOS have the combined risk factors of smoking and atopy, are generally younger than patients with COPD and experience acute exacerbations with higher frequency and greater severity than lone COPD. Pharmacotherapeutic considerations require an integrated approach, first to identify the relevant clinical phenotype(s), then to determine the best available therapy. The authors discuss the array of existing and emerging classes of drugs that could benefit those with ACOS and share their therapeutic approach. A consensus international definition of ACOS is needed to design prospective, randomized clinical trials to evaluate specific drug interventions on important outcomes such as lung function, acute exacerbations, quality of life and mortality.
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Affiliation(s)
- Samuel Louie
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, University of California, Davis, CA 95616, USA
| | - Amir A Zeki
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, University of California, Davis, CA 95616, USA
| | - Michael Schivo
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, University of California, Davis, CA 95616, USA
| | - Andrew L Chan
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, University of California, Davis, CA 95616, USA
- Veterans Administration Northern California Health Care System, Martinez, CA 94553, USA
| | - Ken Y Yoneda
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, University of California, Davis, CA 95616, USA
- Veterans Administration Northern California Health Care System, Martinez, CA 94553, USA
| | - Mark Avdalovic
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, University of California, Davis, CA 95616, USA
- Veterans Administration Northern California Health Care System, Martinez, CA 94553, USA
| | - Brian M Morrissey
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, University of California, Davis, CA 95616, USA
- Veterans Administration Northern California Health Care System, Martinez, CA 94553, USA
| | - Timothy E Albertson
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, University of California, Davis, CA 95616, USA
- Veterans Administration Northern California Health Care System, Martinez, CA 94553, USA
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Lodewijckx C, Decramer M, Sermeus W, Panella M, Deneckere S, Vanhaecht K. Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation. Trials 2012; 13:229. [PMID: 23190552 PMCID: PMC3543249 DOI: 10.1186/1745-6215-13-229] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 10/23/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Optimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness. METHODS The clinical content of a care pathway for COPD exacerbation was developed based on recognized process design and guideline development methods. Subsequently, based on the COPD case study, a generalized eight-step method was designed to support the development of the clinical content of an evidence-based care pathway. RESULTS A set of 38 evidence-based key interventions and a set of 24 process and 15 outcome indicators were developed in eight different steps. Nine Belgian multidisciplinary teams piloted both the set of key interventions and indicators. The key intervention set was judged by the teams as being valid and clinically applicable. In addition, the pilot study showed that the indicators were feasible for the involved clinicians and patients. CONCLUSIONS The set of 38 key interventions and the set of process and outcome indicators were found to be appropriate for the development and standardization of the clinical content of the COPD care pathway in the context of a cRCT on pathway effectiveness. The developed eight-step method may facilitate multidisciplinary teams caring for other patient populations in designing the clinical content of their future care pathways.
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Affiliation(s)
- Cathy Lodewijckx
- Respiratory Department, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
| | - Marc Decramer
- Respiratory Department, University Hospitals Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven University of Leuven, Leuven, Belgium
| | - Walter Sermeus
- Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
| | - Massimiliano Panella
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
- Department of Public Health, Department of Clinical and Experimental Medicine, Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Svin Deneckere
- Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
| | - Kris Vanhaecht
- Department of Public Health, KU Leuven University of Leuven, Leuven, Belgium
- European Pathway Association, Kapucijnenvoer, Leuven, Belgium
- Western Norway Research Network on Integrated Care, Helse Fonna, Haugesund, Norway
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15
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Serrano-Mollar A. [Alveolar epithelial cell injury as an etiopathogenic factor in pulmonary fibrosis]. Arch Bronconeumol 2012; 48 Suppl 2:2-6. [PMID: 23116901 PMCID: PMC7131261 DOI: 10.1016/s0300-2896(12)70044-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterized by a progressive accumulation of extracellular matrix and an imbalance between profibrotic and antifibrotic mediators. In the last few years, understanding of the mechanisms of the biology of IPF has increased. One of the most significant discoveries is the finding that alveolar epithelial cell injury plays an important role in the pathogenesis of this disease. In this review, we describe some of the mechanisms involved in alveolar cell injury and their contribution to the development of IPF.
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Affiliation(s)
- Anna Serrano-Mollar
- Departamento de Patología Experimental, Institut d'Investigacions Biomèdiques de Barcelona, España.
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16
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Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA, Riesco JA, Trigueros JA, Piñera P, Simón A, López-Campos JL, Soriano JB, Ancochea J. [Spanish COPD Guidelines (GesEPOC): Pharmacological treatment of stable COPD]. Aten Primaria 2012; 44:425-37. [PMID: 22704760 PMCID: PMC7025253 DOI: 10.1016/j.aprim.2012.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022] Open
Abstract
Recognizing the clinical heterogeneity of COPD suggests a specific therapeutic approach directed by the so-called clinical phenotypes of the disease. The Spanish COPD Guidelines (GesEPOC) is an initiative of SEPAR, which, together with the scientific societies involved in COPD patient care, and the Spanish Patient Forum, has developed these new clinical practice guidelines. This present article describes the severity classification and the pharmacological treatment of stable COPD. GesEPOC identifies four clinical phenotypes with differential treatment: non-exacerbator, mixed COPD-asthma, exacerbator with emphysema and exacerbator with chronic bronchitis. Pharmacological treatment of COPD is based on bronchodilation in addition to other drugs depending on the clinical phenotype and severity. Severity is established by the BODE/BODEx multidimensional scales. Severity can also be approximated by assessing airflow obstruction, dyspnea, level of physical activity and history of exacerbations. GesEPOC is a new, more individualized approach to COPD treatment according to the clinical characteristics of the patients.
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Affiliation(s)
- Marc Miravitlles
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain.
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Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Quintano JA, Riesco JA, Trigueros JA, Piñera P, Simón A, López-Campos JL, Soriano JB, Ancochea J. Spanish COPD Guidelines (GesEPOC): Pharmacological Treatment of Stable COPD. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Spanish COPD Guidelines (GesEPOC): pharmacological treatment of stable COPD. Spanish Society of Pulmonology and Thoracic Surgery. Arch Bronconeumol 2012; 48:247-57. [PMID: 22561012 DOI: 10.1016/j.arbres.2012.04.001] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/11/2012] [Indexed: 12/14/2022]
Abstract
Recognizing the clinical heterogeneity of COPD suggests a specific therapeutic approach directed by the so-called clinical phenotypes of the disease. The Spanish COPD Guidelines (GesEPOC) is an initiative of SEPAR, which, together with the scientific societies involved in COPD patient care, and the Spanish Patient Forum, has developed these new clinical practice guidelines. This present article describes the severity classification and the pharmacological treatment of stable COPD. GesEPOC identifies four clinical phenotypes with differential treatment: non-exacerbator, mixed COPD-asthma, exacerbator with emphysema and exacerbator with chronic bronchitis. Pharmacological treatment of COPD is based on bronchodilation in addition to other drugs depending on the clinical phenotype and severity. Severity is established by the BODE/BODEx multidimensional scales. Severity can also be approximated by assessing airflow obstruction, dyspnea, level of physical activity and history of exacerbations. GesEPOC is a new, more individualized approach to COPD treatment according to the clinical characteristics of the patients.
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Mentz RJ, Fiuzat M, Kraft M, Lindenfeld J, O’Connor CM. Bronchodilators in Heart Failure Patients With COPD: Is It Time for a Clinical Trial? J Card Fail 2012; 18:413-22. [DOI: 10.1016/j.cardfail.2012.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 01/30/2012] [Accepted: 02/01/2012] [Indexed: 12/22/2022]
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Akgün KM, Crothers K, Pisani M. Epidemiology and management of common pulmonary diseases in older persons. J Gerontol A Biol Sci Med Sci 2012; 67:276-91. [PMID: 22337938 DOI: 10.1093/gerona/glr251] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pulmonary disease prevalence increases with age and contributes to morbidity and mortality in older patients. Dyspnea in older patients is often ascribed to multiple etiologies such as medical comorbidities and deconditioning. Common pulmonary disorders are frequently overlooked as contributors to dyspnea in older patients. In addition to negative impacts on morbidity and mortality, quality of life is reduced in older patients with uncontrolled, undertreated pulmonary symptoms. The purpose of this review is to discuss the epidemiology of common pulmonary diseases, namely pneumonia, chronic obstructive pulmonary disease, asthma, lung cancer, and idiopathic pulmonary fibrosis in older patients. We will review common clinical presentations for these diseases and highlight differences between younger and older patients. We will also briefly discuss risk factors, treatment, and mortality associated with these diseases. Finally, we will address the relationship between comorbidities, pulmonary symptoms, and quality of life in older patients with pulmonary diseases.
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Affiliation(s)
- Kathleen M Akgün
- Pulmonary and Critical Care Section, Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, USA.
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Dhand R, Dolovich M, Chipps B, R. Myers T, Restrepo R, Rosen Farrar J. The Role of Nebulized Therapy in the Management of COPD: Evidence and Recommendations. COPD 2012; 9:58-72. [DOI: 10.3109/15412555.2011.630047] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Joo MJ, Au DH, Fitzgibbon ML, McKell J, Lee TA. Determinants of spirometry use and accuracy of COPD diagnosis in primary care. J Gen Intern Med 2011; 26:1272-7. [PMID: 21713542 PMCID: PMC3208468 DOI: 10.1007/s11606-011-1770-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 06/03/2011] [Accepted: 06/04/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unclear if primary care physicians are following guidelines or using other patient characteristics and factors to determine when to perform spirometry in patients at risk for COPD. It is also unclear to what degree a diagnosis of COPD is accurately reflected by spirometry results. OBJECTIVES To examine characteristics associated with use of spirometry in primary care for patients with increased risk for COPD and to determine the accuracy of COPD diagnosis in patients with spirometry. DESIGN Retrospective cohort study. SUBJECTS A cohort that met the following criteria was identified: ≥35 years of age; ≥ 2 primary care visits in internal medicine clinic in 2007; at least one respiratory or smoking cessation medication, or diagnosis of COPD or shortness of breath or dyspnea in 2007. MAIN MEASURES Medical records of all primary care physician visits prior to the time of inclusion in 2007 were reviewed. Data on patient demographics, co-morbidities, respiratory medication use, presence of symptoms, history of tobacco use, and pulmonary function tests were extracted. KEY RESULTS A total 1052 patients were identified. Dyspnea on exertion (Adjusted odds ratio (AOR) 1.52 [95% CI 1.06-2.18]) and chronic cough (AOR 1.71 [1.07-2.72]) were the only chronic symptoms associated with use of spirometry. Current (AOR 1.54 [0.99-2.40]) or past smoking (AOR 1.09 [0.72-1.65]) status were not associated with use of spirometry. Of the 159 patients with a diagnosis of COPD, 93 (58.5%) met GOLD criteria and 81(50.9%) met lower limit of normal (LLN) criteria for COPD. CONCLUSION Clinicians use spirometry more often among patients with symptoms suggestive of COPD but not more often among patients with current or past tobacco use. For patients who had a spirometry and a diagnosis of COPD, primary care physicians were accurate in their diagnosis only half of the time.
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Affiliation(s)
- Min J Joo
- Section of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
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Documento de consenso sobre enfermedad pulmonar obstructiva crónica en Andalucía-2010. Semergen 2011. [DOI: 10.1016/j.semerg.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cave AC, Hurst MM. The use of long acting β2-agonists, alone or in combination with inhaled corticosteroids, in Chronic Obstructive Pulmonary Disease (COPD). Pharmacol Ther 2011; 130:114-43. [DOI: 10.1016/j.pharmthera.2010.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 12/22/2022]
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Tashkin DP, Fabbri LM. Long-acting beta-agonists in the management of chronic obstructive pulmonary disease: current and future agents. Respir Res 2010; 11:149. [PMID: 21034447 PMCID: PMC2991288 DOI: 10.1186/1465-9921-11-149] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 10/29/2010] [Indexed: 02/08/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation and debilitating symptoms. For patients with moderate-to-severe COPD, long-acting bronchodilators are the mainstay of therapy; as symptoms progress, guidelines recommend combining bronchodilators from different classes to improve efficacy. Inhaled long-acting β2-agonists (LABAs) have been licensed for the treatment of COPD since the late 1990s and include formoterol and salmeterol. They improve lung function, symptoms of breathlessness and exercise limitation, health-related quality of life, and may reduce the rate of exacerbations, although not all patients achieve clinically meaningful improvements in symptoms or health related quality of life. In addition, LABAs have an acceptable safety profile, and are not associated with an increased risk of respiratory mortality, although adverse effects such as palpitations and tremor may limit the dose that can be tolerated. Formoterol and salmeterol have 12-hour durations of action; however, sustained bronchodilation is desirable in COPD. A LABA with a 24-hour duration of action could provide improvements in efficacy, compared with twice-daily LABAs, and the once-daily dosing regimen could help improve compliance. It is also desirable that a new LABA should demonstrate fast onset of action, and a safety profile at least comparable to existing LABAs.A number of novel LABAs with once-daily profiles are in development which may be judged against these criteria. Indacaterol, a LABA with a 24-hour duration of bronchodilation and fast onset of action, is the most advanced of these. Preliminary results from large clinical trials suggest indacaterol improves lung function compared with placebo and other long-acting bronchodilators. Other LABAs with a 24-hour duration of bronchodilation include carmoterol, vilanterol trifenatate and oldaterol, with early results indicating potential for once-daily dosing in humans.The introduction of once-daily LABAs also provides the opportunity to develop combination inhalers of two or more classes of once-daily long-acting bronchodilators, which may be advantageous for COPD patients through simplification of treatment regimens as well as improvements in efficacy. Once-daily LABAs used both alone and in combination with long-acting muscarinic antagonists represent a promising advance in the treatment of COPD, and are likely to further improve outcomes for patients.
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Affiliation(s)
- Donald P Tashkin
- David Geffen School of Medicine, Division of Pulmonary and Critical Care Medicine, UCLA, Los Angeles, California, USA
| | - Leonardo M Fabbri
- Department of Respiratory Diseases, University of Modena & Reggio Emilia, Via del Pozzo 71, I-41124 Modena, Italy
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Matera MG, Martuscelli E, Cazzola M. Pharmacological modulation of β-adrenoceptor function in patients with coexisting chronic obstructive pulmonary disease and chronic heart failure. Pulm Pharmacol Ther 2010; 23:1-8. [DOI: 10.1016/j.pupt.2009.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 09/28/2009] [Accepted: 10/08/2009] [Indexed: 02/01/2023]
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Tratamiento farmacológico de la EPOC. ¿Dónde nos encontramos? Arch Bronconeumol 2010; 46 Suppl 10:3-7. [DOI: 10.1016/s0300-2896(10)70049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Baker WL, Baker EL, Coleman CI. Pharmacologic treatments for chronic obstructive pulmonary disease: a mixed-treatment comparison meta-analysis. Pharmacotherapy 2009; 29:891-905. [PMID: 19637942 DOI: 10.1592/phco.29.8.891] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
STUDY OBJECTIVE To assess the comparative efficacy of pharmacologic agents for the maintenance treatment of chronic obstructive pulmonary disease (COPD). DESIGN Traditional and mixed-treatment comparison (MTC) meta-analyses of randomized controlled trials. PATIENTS A total of 31,020 patients with COPD from 43 trials. MEASUREMENTS AND MAIN RESULTS A systematic literature search of various databases (through October 2007) was performed to identify randomized controlled trials of long-acting beta(2)-agonists, tiotropium, inhaled corticosteroids, and/or combination therapy with an inhaled corticosteroid and a long-acting beta(2)-agonist in patients with COPD. Forty-three trials were included. Both meta-analyses were used to evaluate the occurrence of one or more episodes of COPD exacerbation, overall mortality, and patient withdrawal rates. With MTC analysis, long-acting beta(2)-agonists, tiotropium, inhaled corticosteroids, and combination inhaled corticosteroid-long-acting beta(2)-agonist therapy each decreased the odds of having an exacerbation by 16%, 31%, 15%, and 24%, respectively, compared with placebo. Moreover, tiotropium use reduced the odds of having at least one exacerbation by 18% compared with long-acting beta(2)-agonists and by 19% compared with inhaled corticosteroids alone. Each of the four drug classes was associated with significant odds reductions in patient withdrawals (26-41%) compared with placebo, and both tiotropium and combination therapy significantly decreased the odds of patient withdrawals compared with long-acting beta(2)-agonists or inhaled corticosteroids alone. Only combination therapy was associated with a mortality benefit, showing a 29% reduction compared with placebo and a 25% reduction compared with long-acting beta(2)-agonists alone. Compared with combination therapy, tiotropium use reduced exacerbations by 9% and increased mortality by only 4%. These findings did not demonstrate significant changes in the sensitivity or subgroup analyses, which were performed to evaluate the effect of heterogeneity among the included studies. CONCLUSIONS Combination inhaled corticosteroid-long-acting beta(2)-agonist therapy was associated with the greatest positive effect on outcomes in patients with COPD. Of the bronchodilator monotherapies, tiotropium was associated with lower odds of having a COPD exacerbation or withdrawal from a study compared with long-acting beta(2)-agonists.
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Affiliation(s)
- William L Baker
- Hartford Hospital Drug Information Center, Hartford, Connecticut 06102-5037, USA
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Anderson D, Macnee W. Targeted treatment in COPD: a multi-system approach for a multi-system disease. Int J Chron Obstruct Pulmon Dis 2009; 4:321-35. [PMID: 19750192 PMCID: PMC2740954 DOI: 10.2147/copd.s2999] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Chronic obstructive pulmonary disease is a varied condition when examined from a number of different perspectives including factors which influence disease development, pathological process and clinical features. There may be a complex interaction between the degree by which each of these processes influences the development of COPD and the subsequent clinical phenotype with which the patient presents. The varied host response and subsequent clinical phenotype has generated much interest in recent years. It is possible that failure of treatment to impact on mortality and reverse the disease process is because of the heterogeneous nature of the condition. Identification and targeted treatment of clinical and pathological phenotypes within the broad spectrum of COPD may therefore improve outcome. This article will review previous work which has attempted to phenotype COPD and identify if specific treatment for these phenotypes has been shown to be of benefit. It will examine the work on pathological processes and clinical manifestations, both pulmonary and systemic, and will focus on pharmacological therapies.
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Dzierba AL, Jelic S. Chronic obstructive pulmonary disease in the elderly: an update on pharmacological management. Drugs Aging 2009; 26:447-56. [PMID: 19591519 DOI: 10.2165/00002512-200926060-00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The prevalence of chronic obstructive pulmonary disease (COPD) continues to rise in association with an aging Western society. While barriers to receiving optimal healthcare exist for aging patients, pharmacotherapy of COPD in the elderly is important because the treatment benefits in this group are comparable to those seen in the younger COPD population. The frequent presence of co-morbidities and reduced clearance capacity make selection of pharmacotherapy in elderly patients with stable COPD challenging. The adverse effects of standard therapy for COPD may also be more pronounced in elderly patients. A careful risk-versus-benefit assessment should always be carried out when prescribing long-term inhaled bronchodilator and corticosteroid therapy to an elderly COPD patient, and when prescribing beta(2)-adrenoceptor agonists and methylxanthines, in particular, to those with cardiovascular co-morbidities. The present review focuses on the special considerations regarding initiation and maintenance of pharmacotherapy in elderly patients with stable COPD.
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Affiliation(s)
- Amy L Dzierba
- Department of Pharmacy, New York Presbyterian Hospital, Columbia University, New York, New York, USA
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31
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Joo MJ, Lee TA, Au DH, Fitzgibbon ML, Weiss KB. Medication Use Patterns Associated with Spirometry in Diagnosing COPD. COPD 2009; 5:360-8. [DOI: 10.1080/15412550802522346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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López-Campos Bodineau J, Morán Rodríguez A, Álvarez Gutiérrez F, Arenas Gordillo M, Barchilón Cohen V, Casas Maldonado F, Fernández Guerra J, Fernández Ruiz J, González Jiménez A, Hidalgo Requena A, Jiménez de la Cruz M, Lubián López M, Marín Sánchez F, Ortega Ruiz F, Quintano Jiménez J, Rojas Villegas J, Solís de Dios M, Soto Campos G. Documento de Consenso en Andalucía: enfermedad pulmonar obstructiva crónica. Semergen 2009. [DOI: 10.1016/s1138-3593(09)71368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hanania NA, Sharafkhaneh A. Update on the pharmacologic therapy for chronic obstructive pulmonary disease. Clin Chest Med 2007; 28:589-607, vi-vii. [PMID: 17720046 DOI: 10.1016/j.ccm.2007.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Chronic obstructive pulmonary disease is a treatable disease characterized by progressive airflow limitation. Prevention of disease progression; improvement of symptoms, exercise tolerance, and health status; and decrease in exacerbations and mortality are the goals of management. Inhaled short-acting bronchodilators are recommended for symptoms in mild disease, whereas inhaled long-acting bronchodilators are recommended for maintenance therapy of daily symptoms. When symptoms are not controlled using one bronchodilator, combining bronchodilators may be more effective. Combining a long-acting beta-agonist with an inhaled corticosteroid is more effective than either agent alone. Several novel therapies are in different stages of development.
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Affiliation(s)
- Nicola A Hanania
- Asthma Clinical Research Center, Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA.
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