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Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. The benefits of triple therapy for chronic obstructive pulmonary disease (COPD) with an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA), as compared with dual therapy (either inhaled glucocorticoid-LABA or LAMA-LABA), are uncertain.In this randomized trial involving 10,355 patients with COPD, we compared 52 weeks of a once-daily combination of fluticasone furoate (...) (an inhaled glucocorticoid) at a dose of 100 μg, umeclidinium (a LAMA) at a dose of 62.5 μg, and vilanterol (a LABA) at a dose of 25 μg (triple therapy) with fluticasone furoate-vilanterol (at doses of 100 μg and 25 μg, respectively) and umeclidinium-vilanterol (at doses of 62.5 μg and 25 μg, respectively). Each regimen was administered in a single Ellipta inhaler. The primary outcome was the annual rate of moderate or severe COPD exacerbations during treatment.The rate of moderate or severe exacerbations
Noninvasive ventilation in stable hypercapnic COPD: what is the evidence? Long-term noninvasive ventilation (NIV) to treat chronic hypercapnic respiratory failure is still controversial in severe chronic obstructive pulmonary disease (COPD) patients. However, with the introduction of high-intensity NIV, important benefits from this therapy have also been shown in COPD. In this review, the focus will be on the arguments for long-term NIV at home in patients with COPD. The rise of (high-intensity (...) ) NIV in COPD and the randomised controlled trials showing positive effects with this mode of ventilation will be discussed. Finally, the challenges that might be encountered (both in clinical practice and in research) in further optimising this therapy, monitoring and following patients, and selecting the patients who might benefit most will be reviewed.
Initial treatment with high-pressure oxygen reduces deaths in severe flare-ups of COPD Use of a facemask ventilator can reduce deaths in severe flare-ups of COPD Discover Portal Discover Portal Use of a facemask ventilator can reduce deaths in severe flare-ups of COPD Published on 19 September 2017 doi: People admitted to hospital with a severe exacerbation of chronic obstructive pulmonary disease (COPD) were 46% less likely to die if they received non-invasive ventilation. Only 12% of those (...) receiving non-invasive ventilation needed subsequent invasive ventilation via a tube, compared to 34% of those who had usual care. This review identified 17 trials of adults with a severe acute exacerbation of COPD with high carbon dioxide levels. Trials compared usual care, including steroids and antibiotics with usual care plus non-invasive ventilation, which delivers air at high pressure via a mask. Airways are forced open and respiratory muscles can rest. This updated review shows benefits
Pneumococcal vaccines for people with COPD reduce their chance of catching pneumonia Pneumococcal vaccines for people with COPD reduce their chance of catching pneumonia Discover Portal Discover Portal Pneumococcal vaccines for people with COPD reduce their chance of catching pneumonia Published on 30 May 2017 doi: Pneumococcal vaccines reduce the risk of community-acquired pneumonia in people with moderate to severe chronic obstructive pulmonary disease (COPD). Pneumococcal vaccination (...) is currently recommended for people with COPD and other respiratory diseases. However, until now there has been a lack of data whether it actually improves outcomes in these groups. This updated Cochrane review identified 12 trials including 2171 adults with COPD, comparing those who did and did not receive pneumococcal vaccination. One episode of community-acquired pneumonia was prevented for every 21 people vaccinated. There was also evidence that vaccination reduced the risk of exacerbations of COPD
Potential alternative to painful blood tests in people with flare-ups of COPD Potential alternative to painful blood tests in people with flare-ups of COPD Discover Portal Discover Portal Potential alternative to painful blood tests in people with flare-ups of COPD Published on 27 September 2016 doi: It may be possible to use venous blood and pulse oximeters to initially assess the severity of a flare up of chronic obstructive pulmonary disease (COPD). Blood gas levels were similar in people (...) when testing blood from either arteries (the recommended test) or veins. Oxygen saturation using pulse oximeters – which attach to the end of the finger – were also reasonably accurate compared to testing arterial blood. Flare-ups of COPD – where the person’s condition suddenly deteriorates – are the second most common cause of emergency hospital admissions in the UK. It is important to assess how serious a flare-up is by testing blood for gases such as carbon dioxide and oxygen. Taking an arterial
Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomised trial The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronic obstructive pulmonary disease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe (...) or very severe COPD patients were allocated to follow PRP+IMT versus PRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure (PImax), inspiratory
Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD(+)): a randomised controlled trial We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety (...) and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control
Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture It is uncertain whether long-term use of inhaled corticosteroids (ICSs), widely used to treat COPD, increases the risk of fracture, particularly in women, in view of the postmenopausal risks. We assessed whether long-term ICS use in patients with COPD increases the risk of hip or upper extremity fractures, and examined sex-related differences.The Quebec health-care databases were used to form a cohort of patients (...) with COPD over 1990 to 2005, followed until 2007 for the first hip or upper extremity fracture. In a nested case-control analysis, each case of fracture was matched with 20 control subjects on age, sex, and follow-up time. The adjusted rate ratio (RR) of fracture with ICS use, by duration and dose, was estimated using conditional logistic regression, with an interaction term to compare the risk in men and women.In the cohort of 240,110 subjects, 19,396 sustained a fracture during a mean 5.3 years (rate
The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation Journals Library An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page
COPD: time to improve its taxonomy? Due to well-conducted epidemiological studies and advances in genetics, molecular biology, translational research, the advent of computed tomography of the lungs and bioinformatics, the diagnosis of chronic obstructive pulmonary disease (COPD) as a single entity caused by susceptibility to cigarette smoke is no longer tenable. Furthermore, the once-accepted concept that COPD results from a rapid and progressive loss of lung function over time is not true (...) for a sizeable proportion of adults with the disease. Now we know that some genetic predisposition and/or different environmental interactions (nutritional, infectious, pollution and immunological) may negatively modulate post-natal lung development and lead to poorly reversible airflow limitation later in life, consistent with COPD. We believe it is time to rethink the taxonomy of this disease based on the evidence at hand. To do so, we have followed the principles outlined in the 1980s by J.D. Scadding who
Do-not-resuscitate orders as part of advance care planning in patients with COPD There is growing awareness of the need for advance care planning in patients with chronic obstructive pulmonary disease (COPD). However, do-not-resuscitate (DNR) order implementation remains a challenge in clinical practice. We retrospectively analysed an observational cohort of 569 COPD patients with 2.5-8 years of follow-up in secondary care, to evaluate potential determinants and the prognostic significance
Core IM: Mind the Gap on COPD Classifications Core IM: Mind the Gap on COPD Classifications – Clinical Correlations Search Core IM: Mind the Gap on COPD Classifications February 14, 2018 3 min read Podcast: | Subscribe: | Let’s go deeper into to why we think about diseases the way we do: Classifications for COPD through the Years! Written by Dr. Steve Liu and Dr. Carolyn Drake || Hosted by Dr. Steve Liu, Dr. Carolyn Drake & Dr. Janine Knudsen || Graphic Design by Mr. Ramon Thompson Time Stamps (...) How did prior understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25) How is COPD diagnosed? (6:13) How has COPD been classified and why? (6:42) Subscribe to CORE IM on any podcast app! Follow us on Facebook || Twitter || Instagram . Please give any feedback at . Show Notes : Chronic Obstructive Lung Disease (COPD) , is a disease of small airway inflammation defined by at FEV1/FVC ratio less than 0.70 and symptoms of chronic bronchitis and/or emphysema. In 1998
Inhaled long acting Beta-2 (?2) agonists for COPD Inhaled long acting ß2 agonists for COPD November - December 2017 Mailing Address: Therapeutics Initiative The University of British Columbia Department of Anesthesiology, Pharmacology & Therapeutics 2176 Health Sciences Mall Vancouver, BC Canada V6T 1Z3 Tel.: 604 822 0700 Fax: 604 822 0701 E-mail: firstname.lastname@example.org www.ti.ubc.ca 109 I n Therapeutics Letter #102 1 we reviewed the inhaled long acting ß2 agonist (LABA) indacaterol for chronic obstruc (...) - tive pulmonary disease (COPD). We concluded “There are no proven clinically meaningful benefits in terms of reduc- tion in mortality or total serious adverse events…” for this indication based on 12 trials in 6,947 patients. In this Letter we report systematic reviews of 3 other inhaled LABA drugs licensed for COPD: formoterol, arformoterol and salmeterol. Objective To determine the clinical efficacy of inhaled formoterol, arformoterol and salmeterol as compared to placebo for chronic maintenance
Fluticasone furoate / umeclidinium / vilanterol (Trelegy Ellipta) - maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) Published 12 February 2018 Product Update fluticasone furoate, umeclidinium, vilanterol (as trifenatate) 92 micrograms / 55 micrograms / 22 micrograms inhalation powder (Trelegy ® Ellipta ® ) SMC No 1303/18 GlaxoSmithKline UK 12 January 2018 The Scottish Medicines Consortium (SMC) has completed its assessment (...) of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHS Scotland. The advice is summarised as follows: ADVICE: following an abbreviated submission fluticasone furoate / umeclidinium / vilanterol (as trifenatate) (Trelegy ® Ellipta ® ) is accepted for restricted use within NHS Scotland. Indication under review: maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) who are not adequately treated
Effects of umeclidinium/vilanterol on exercise endurance in COPD: a randomised study This multicentre, randomised, double-blind, placebo-controlled, two-period crossover study assessed the effect of umeclidinium/vilanterol (UMEC/VI) on exercise capacity in patients with chronic obstructive pulmonary disease (COPD) using the endurance shuttle walk test (ESWT). Patients were randomised 1:1 to one of two treatment sequences: 1) UMEC/VI 62.5/25 µg followed by placebo or 2) placebo followed by UMEC (...) /VI 62.5/25 µg. Each treatment was taken once daily for 12 weeks. The primary end-point was 3-h post-dose exercise endurance time (EET) at week 12. Secondary end-points included trough forced expiratory volume in 1 s (FEV1) and 3-h post-dose functional residual capacity (FRC), both at week 12. COPD Assessment Test (CAT) score at week 12 was also assessed. UMEC/VI treatment did not result in a statistically significant improvement in EET change from baseline at week 12 versus placebo (p=0.790