http://www.ncbi.nlm.nih.gov/pubmed/33185464?tool=bestpractice.com, For patients prescribed home oxygen therapy, the ATS recommends that the patient and their caregivers should receive instruction and training on the use and maintenance of all oxygen equipment and education on oxygen safety, including smoking cessation, fire prevention, and tripping hazards. [1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Bronchoscopic lung volume reduction procedures for chronic obstructive pulmonary disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001001.pub3/full https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf Endobronchial valve insertion can produce clinically meaningful improvements in appropriately selected patients with COPD. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. http://www.ncbi.nlm.nih.gov/pubmed/29429593?tool=bestpractice.com http://www.ncbi.nlm.nih.gov/pubmed/31539602?tool=bestpractice.com, 1st line – LABA/LAMA or LABA/ICS or LABA/LAMA/ICS. 2006 Apr 19;(2):CD001387. May 2016 [internet publication]. Long-term triple therapy de-escalation to indacaterol/glycopyrronium in patients with chronic obstructive pulmonary disease (SUNSET): a randomized, double-blind, triple-dummy clinical trial. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Eur Respir J. Changing inhaler device or molecules may be considered. 2002;(4):CD003902. Chronic obstructive pulmonary disease (COPD) includes two separate lung problems, emphysema and chronic bronchitis. [1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf Cochrane Database Syst Rev. https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf End-of-life care and hospice admission should be considered for patients with very advanced disease. 2021 [internet publication]. Inhaler mishandling remains common in real life and is associated with reduced disease control. http://www.ncbi.nlm.nih.gov/pubmed/32579807?tool=bestpractice.com https://www.doi.org/10.1183/13993003.01586-2018 Dyspnoea due to other causes should be considered, investigated, and treated. N Engl J Med. Respir Res. Respir Med. Another randomized controlled trial had similar findings in terms of mortality in the triple therapy arm (budesonide/glycopyrrolate/formoterol), but only at the higher dose of ICS. [56]Rabe KF, Martinez FJ, Ferguson GT, et al. If antibiotic therapy is not effective it should be stopped. https://www.doi.org/10.1136/thoraxjnl-2019-213929 2021 [internet publication]. http://www.ncbi.nlm.nih.gov/pubmed/31539602?tool=bestpractice.com, GOLD group A, B, C, or D: persistent exacerbations after initial therapy. Tashkin DP, Pearle J, Iezzoni D, et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD. Thorax. July 2019 [internet publication]. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. 2021 [internet publication]. 2016;10:1045-1055. http://www.ncbi.nlm.nih.gov/pubmed/27552524?tool=bestpractice.com. Cochrane Database Syst Rev. Pascoe S, Barnes N, Brusselle G, et al. Combination inhaled steroid and long-acting beta₂-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease. [New, 2017] • Develop an exacerbation action plan with the patient for pharmacologic therapies including short-acting bronchodilators, oral corticosteroids, and antibiotics. Int J Chron Obstruct Pulmon Dis. 2019 Sep;7(9):745-56. https://www.doi.org/10.1183/13993003.01586-2018 [1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial. 2018 Feb;6(2):117-26. Opioid analgesics, fans, neuromuscular electrical stimulation, and chest wall vibration can relieve dyspnoea. 2018 Aug 1;198(3):329-39. https://www.doi.org/10.1164/rccm.201803-0405OC, http://www.ncbi.nlm.nih.gov/pubmed/29779416?tool=bestpractice.com, 250 mg orally once daily; or 500 mg orally three times weekly. https://www.doi.org/10.1164/rccm.201502-0235LE Albert RK, Connett J, Bailey WC, et al. Cochrane Database Syst Rev. [54]Cazzola M, Rogliani P, Calzetta L, et al. Before starting prophylactic antibiotics, baseline ECG and liver function tests should be performed, a sputum sample obtained for culture and sensitivity (including tuberculosis testing), the patient’s sputum clearance technique should be optimised, and bronchiectasis should be excluding with a CT scan. [51]Lipson DA, Barnhart F, Brealey N, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Dyspnea due to other causes should be considered, investigated, and treated. Indacaterol/glycopyrrolate showed superior efficacy compared with glycopyrrolate or tiotropium in patients with moderate to severe COPD, and compared with salmeterol/fluticasone in preventing COPD exacerbation. However, lung transplantation does not appear to confer a survival benefit. 2020 Nov 15;202(10):e121-41. [1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). Concomitant treatment with nebulized formoterol and tiotropium in subjects with COPD: a placebo-controlled trial. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. [96]Lipson DA, Crim C, Criner GJ, et al. [1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). http://www.ncbi.nlm.nih.gov/pubmed/31281061?tool=bestpractice.com, Patients on LABA or LAMA who experience persistent exacerbations and who have blood eosinophils <100 cells/microliter or who have contraindications to ICS should commence a LABA/LAMA. 2016 Jun 6;(6):CD008532. However, erdosteine may have a significant effect on mild exacerbations whether or not the patient is taking inhaled corticosteroids. Patients taking a long-acting beta-2 agonist (LABA) or long-acting muscarinic antagonist (LAMA) alone and who experience persistent exacerbations should increase therapy to either LABA/LAMA or LABA/inhaled corticosteroid (ICS). Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by shortness of breath, cough and sputum production. 2021 [internet publication]. https://www.jhltonline.org/article/S1053-2498(14)01181-4/fulltext Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 1st line – LAMA or LABA/LAMA or LABA/ICS, umeclidinium/vilanterol inhaled: (62.5/25 micrograms/dose inhaler) 1 puff once daily, glycopyrrolate/formoterol fumarate inhaled: (9/4.8 micrograms/dose inhaler) 2 puffs twice daily, indacaterol/glycopyrrolate inhaled: (27.5/15.6 micrograms/capsule inhaler) 1 capsule twice daily, tiotropium/olodaterol inhaled: (2.5/2.5 micrograms/dose inhaler) 2 puffs once daily, aclidinium bromide/formoterol fumarate inhaled: (400/12 micrograms/dose inhaler) 1 puff twice daily, fluticasone furoate/vilanterol inhaled: (100/25 micrograms/dose inhaler) 1 puff once daily, fluticasone propionate/salmeterol inhaled: (250/50 micrograms/dose inhaler) 1 puff twice daily, budesonide/formoterol inhaled: (160/4.5 micrograms/dose inhaler) 2 puffs twice daily, mometasone/formoterol inhaled: (100/5 micrograms/dose inhaler; 200/5 micrograms/dose inhaler) 2 puffs twice daily. How does umeclidinium bromide compare with placebo for people with chronic obstructive pulmonary disease (COPD)?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1829/fullShow me the answer, Treatment recommended for ALL patients in selected patient group. Background: Diagnostic and treatment strategies for chronic obstructive pulmonary disease (COPD) vary greatly. [154]Stavem K, Bjørtuft Ø, Borgan Ø, et al. https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf, LAMA is the first choice for most patients. Long-term triple therapy de-escalation to indacaterol/glycopyrronium in patients with chronic obstructive pulmonary disease (SUNSET): a randomized, double-blind, triple-dummy clinical trial. Lung transplantation in patients with chronic obstructive pulmonary disease in a national cohort is without obvious survival benefit. What are the effects of influenza vaccine in people with chronic obstructive pulmonary disease (COPD)?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.2235/fullShow me the answer The Centers for Disease Control and Prevention (CDC) also recommends the tetanus/diphtheria/pertussis vaccine in people with COPD who were not vaccinated in adolescence. [96]Lipson DA, Crim C, Criner GJ, et al. [114]Cho-Reyes S, Celli BR, Dembek C, et al. Multiple studies support triple therapy with LABA/LAMA/ICS as being superior to single- or double-agent therapy with LABA/LAMA or LABA/ICS regarding rate of moderate to severe COPD exacerbations and rate of hospitalization. Blood eosinophils: a biomarker of response to extrafine beclomethasone/formoterol in chronic obstructive pulmonary disease. Despite international efforts to standardize the management of COPD, two-thirds of primary care patients are not diagnosed, treated, or managed according to current evidence-based guidelines, probably because of the difficulty of applying these in routine … Former smokers are more corticosteroid-responsive than current smokers at any eosinophil count. Rogliani P, Matera MG, Page C, et al. [45]Bafadhel M, Peterson S, De Blas MA, et al. rule in COPD include a smoking history of more than 40 pack-years, a self-reported history of COPD, maximal laryn - geal height, and age older than 45 years. 2017 Aug 15;196(4):438-46. https://www.atsjournals.org/doi/full/10.1164/rccm.201703-0449OC, http://www.ncbi.nlm.nih.gov/pubmed/28375647?tool=bestpractice.com. [48]Vestbo J, Papi A, Corradi M, et al. Respir Med. https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf 2011;364:1093-1103. A LABA/LAMA combination should be considered if the patient is highly symptomatic (COPD assessment test [CAT] score >20), especially if the patient has significant dyspnoea and/or exercise limitation. Home oxygen therapy for adults with chronic lung disease. 2006 Apr 19;(2):CD001387. An official American Thoracic Society clinical practice guideline. Short-acting beta-2 agonists (SABAs) and short-acting muscarinic antagonists (SAMAs) improve lung function and breathlessness and quality of life. http://www.ncbi.nlm.nih.gov/pubmed/23204123?tool=bestpractice.com https://www.nice.org.uk/guidance/ng115 [1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). http://www.ncbi.nlm.nih.gov/pubmed/16399534?tool=bestpractice.com, Palliative therapies to improve symptoms of dyspnea, offer nutritional support, address anxiety and depression, and reduce fatigue may benefit patients with COPD who experience these despite optimal medical therapy. No medication has been shown to modify the long-term decline in lung function, and the primary goal of pharmacotherapy is to control symptoms and prevent complications. [1]Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2018 Dec 13;52(6):1801230. https://www.doi.org/10.1183/13993003.01230-2018, http://www.ncbi.nlm.nih.gov/pubmed/30209195?tool=bestpractice.com. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 1st line – LAMA or LABA/LAMA or LABA/ICS, umeclidinium/vilanterol inhaled: (62.5/25 micrograms/dose inhaler) 1 puff once daily, glycopyrronium/formoterol fumarate inhaled: (14.4/9.6 micrograms/dose inhaler) 1 puff twice daily, indacaterol/glycopyrronium inhaled: (110/50 micrograms/capsule inhaler) 1 capsule once daily, tiotropium/olodaterol inhaled: (2.5/2.5 micrograms/dose inhaler) 2 puffs once daily, aclidinium bromide/formoterol fumarate inhaled: (400/12 micrograms/dose inhaler) 1 puff twice daily, fluticasone furoate/vilanterol inhaled: (100/25 micrograms/dose inhaler) 1 puff once daily, fluticasone propionate/salmeterol inhaled: (250/50 micrograms/dose inhaler) 1 puff twice daily, budesonide/formoterol inhaled: (160/4.5 micrograms/dose inhaler) 2 puffs twice daily, mometasone/formoterol inhaled: (100/5 micrograms/dose inhaler; 200/5 micrograms/dose inhaler) 2 puffs twice daily. 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