COPDX: an update of guidelines for the management of chronic obstructive pulmonary disease with a review of recent evidence.
Long-acting beta(2) agonists are an effective and convenient treatment for chronic obstructive pulmonary disease (COPD), but do not significantly improve lung function. The long-acting anticholinergic tiotropium, which can be taken once daily, decreases exertional dyspnoea and increases endurance by reducing hyperinflation. The role in COPD of the combination of a long-acting beta(2) agonist and a glucocorticoid in a single inhaler remains unclear. The minimum duration of an effective pulmonary rehabilitation program that includes exercise training is 6 weeks. Long-term treatment with inhaled glucocorticoids may reduce the rate of decline in lung function, but the effect is small. Aminophylline should no longer be routinely used in acute exacerbations of COPD. Non-invasive positive pressure ventilation (NPPV) reduces mortality and hospital stay in patients with acute hypercapnic ventilatory failure; it is also an effective weaning strategy for patients who require intubation. Further studies are required to clarify the role of NPPV in the long-term management of stable COPD.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC. michael.abramson@med.monash.edu.au
Michael J
MJ
Abramson
Alan J
AJ
Crockett
Peter A
PA
Frith
Christine F
CF
McDonald
D000280:Administration, Inhalation; D000284:Administration, Oral; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D001249:Asthma / Q000175:diagnosis; D001315:Australia; D001993:Bronchodilator Agents / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004338:Drug Combinations; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards; D005100:Expectorants / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000628:therapy*; D012129:Respiratory Function Tests; D012307:Risk Factors; D012602:Scopolamine Derivatives / Q000008:administration & dosage; D012944:Social Support; D000069447:Tiotropium Bromide; D014611:Vaccination / Q000592:standards
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D004338:Drug Combinations; D005100:Expectorants; D005938:Glucocorticoids; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide