Patients With Chronic Obstructive Pulmonary Disease Exacerbations: Recommendations for Diagnosis, Treatment and Care

Navarrete, Bernardino Alcázar; Bermúdez, Julio Ancochea; García‐Río, Francisco; Alonso, José L.; Miravitlles, Marc; González-Moro, José Miguel Rodríguez; Soler-Cataluña, Juan José

doi:10.1016/j.arbr.2019.02.011

“…Patients with COPD, even those with mild disease, can experience exacerbations [ 48 – 51 ], which account for a large proportion of total COPD burden on the healthcare system [ 52 , 53 ]. Recommendations for reducing COPD exacerbations and treatment of stable COPD have been provided by GOLD [ 2 ], the European Respiratory Society/American Thoracic Society [ 54 ], and the Spanish Society of Pulmonology and Thoracic Surgery [ 55 , 56 ]. The efficacy of tiotropium 18 μg QD in reducing exacerbations was evaluated in several short- and long-term studies, including those mentioned above (Table 1 ; summarized by Anzueto et al [ 57 ]).…”

Section: Initial Studies With Tiotropium Inhalation Powdermentioning

confidence: 99%

Tiotropium in chronic obstructive pulmonary disease – a review of clinical development

Anzueto

¹

,

Miravitlles

²

2020

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Background: Bronchodilators are the mainstay of pharmacological treatment in chronic obstructive pulmonary disease (COPD), and long-acting muscarinic antagonist (LAMA) monotherapy is recommended as initial treatment for Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups B, C, and D. Main body: Tiotropium bromide was the first LAMA available for COPD in clinical practice and, because of its long duration of action, is administered once daily. Tiotropium was initially available as an inhalation powder delivered via a dry-powder inhaler (DPI). Later, tiotropium also became available as an inhalation spray delivered via a soft mist inhaler (SMI). The SMI was designed to overcome or minimize some of the issues associated with other inhaler types (eg, the need for strong inspiratory airflow with DPIs). Results of short-and long-term randomized, controlled clinical trials of tiotropium in patients with COPD indicated tiotropium was safe and significantly improved lung function, health-related quality of life, and exercise endurance, and reduced dyspnea, lung hyperinflation, exacerbations, and use of rescue medication compared with placebo or active comparators. These positive efficacy findings triggered the evaluation of tiotropium in fixed-dose combination with olodaterol (a long-acting β 2-agonist). In this review, we provide an overview of studies of tiotropium for the treatment of COPD, with a focus on pivotal studies. Conclusion: Tiotropium is safe and efficacious as a long-term, once-daily LAMA for the maintenance treatment of COPD and for reducing COPD exacerbations. The SMI generates a low-velocity, long-duration aerosol spray with a high fine-particle fraction, which results in marked lung drug deposition. In addition, high inspiratory flow rates are not required.

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“…The Spanish guidelines include the level of risk that also depends on the degree of lung function impairment [5]. However, there are no clear rules of evaluation of success and continuation of treatment; in other words, when and how treatment must be stepped up or down [39]. In this context, control status can be a simple tool that can be used at any healthcare level, because all the variables required can be obtained at each clinical visit without any costly diagnostic procedure.…”

Section: The Use Of Control In Clinical Practicementioning

confidence: 99%

The concept of control in chronic obstructive pulmonary disease: Development of the criteria and validation for use in clinical practice

Miravitlles

¹

,

Alcázar²,

Soler-Cataluña

³

2020

Pulʹmonologiâ (Mosk.)

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Guidelines of treatment of chronic obstructive pulmonary disease (COPD) identify symptom reduction and prevention of exacerbations as the main goals of therapy. Initial pharmacological treatment must be guided by these parameters, and effectiveness must be assessed at each clinical visit. However, there is no clear guidance as to how this assessment must be performed. The concept of control has been well developed in asthma, but it has been elusive in COPD. Patients with COPD may not be completely free from symptoms or exacerbations even under optimized therapy; therefore, control in COPD does not mean cure or absence of symptoms, but rather reaching the best clinical status possible according to the level of disease severity. A control tool has been developed based on a cross sectional evaluation of the impact of the disease and a longitudinal evaluation of stability. Low impact is a disease status defined by at least 3 of the following: low levels of dyspnoea, absence of or white sputum, low use of rescue medication and self-declared walking time of more than 30 minutes a day, and stability is the absence of moderate or severe exacerbations in the previous 3 months. Control can also be defined by COPD Assessment Test (CAT) scores ≤ 10 units for patients with FEV1 ≥ 50% and 16 for patients with FEV1 < 50% and stability as a change in CAT ≤ 2 units. Control of COPD is then defined as a status of low impact and stability. The control tool has been validated prospectively in several studies and has demonstrated to be sensitive to clinical changes and to have a good predictive value for poor outcomes. Clinical criteria are more reliable than CAT scores for the evaluation of control. The control tool is a quick and inexpensive method to evaluate clinical status and future risk of exacerbations that can be used at all levels of healthcare.

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“…Ведение пациентов с ХОБЛ по GOLD основывается на симптоматике, которая в основном сводится к одышке и риску обострений [4,38]. Рекомендации, принятые в Испании, включают также уровень риска, который также зависит от степени снижения функции легких [5], однако четкие правила определения успешности лечения и принятия решений о его продолжении (о том, когда и в какой мере следует повышать или понижать интенсивность лечения) отсутствуют [39]. На этом фоне статус контроля может использоваться как простой инструмент на любом уровне здравоохранения, поскольку все данные для его определения можно получить при любом посещении пациентом врача без дорогостоящих диагностических процедур.…”

Section: использование концепции контроля в клинической практикеunclassified

The concept of control in chronic obstructive pulmonary disease: Development of the criteria and validation for use in clinical practice

Миравильес

¹

,

Алькасар²,

Солер-Каталунья

³

2020

Pulʹmonologiâ (Mosk.)

1

0

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Guidelines of treatment of chronic obstructive pulmonary disease (COPD) identify symptom reduction and prevention of exacerbations as the main goals of therapy. Initial pharmacological treatment must be guided by these parameters, and effectiveness must be assessed at each clinical visit. However, there is no clear guidance as to how this assessment must be performed. The concept of control has been well developed in asthma, but it has been elusive in COPD. Patients with COPD may not be completely free from symptoms or exacerbations even under optimized therapy; therefore, control in COPD does not mean cure or absence of symptoms, but rather reaching the best clinical status possible according to the level of disease severity. A control tool has been developed based on a cross sectional evaluation of the impact of the disease and a longitudinal evaluation of stability. Low impact is a disease status defined by at least 3 of the following: low levels of dyspnoea, absence of or white sputum, low use of rescue medication and self-declared walking time of more than 30 minutes a day, and stability is the absence of moderate or severe exacerbations in the previous 3 months. Control can also be defined by COPD Assessment Test (CAT) scores ≤ 10 units for patients with FEV1 ≥ 50% and 16 for patients with FEV1 < 50% and stability as a change in CAT ≤ 2 units. Control of COPD is then defined as a status of low impact and stability. The control tool has been validated prospectively in several studies and has demonstrated to be sensitive to clinical changes and to have a good predictive value for poor outcomes. Clinical criteria are more reliable than CAT scores for the evaluation of control. The control tool is a quick and inexpensive method to evaluate clinical status and future risk of exacerbations that can be used at all levels of healthcare.

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Patients With Chronic Obstructive Pulmonary Disease Exacerbations: Recommendations for Diagnosis, Treatment and Care

Cited by 12 publications

References 35 publications

Tiotropium in chronic obstructive pulmonary disease – a review of clinical development

Tiotropium in chronic obstructive pulmonary disease – a review of clinical development

The concept of control in chronic obstructive pulmonary disease: Development of the criteria and validation for use in clinical practice

The concept of control in chronic obstructive pulmonary disease: Development of the criteria and validation for use in clinical practice

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