Interventions to reduce the frequency of exacerbations of chronic obstructive pulmonary disease.
Frequent exacerbations of chronic obstructive pulmonary disease (COPD) are associated with impaired quality of life, and hospital admissions for exacerbations account for a large proportion of the expenditure of COPD. An important objective when treating COPD is to reduce the frequency of exacerbations. Studies published in the last few years have increased our knowledge on how to prevent exacerbations, but a number of questions remain unanswered. Tiotropium, inhaled steroids and long-acting inhaled beta agonists reduce the frequency of exacerbations, but further studies are necessary to determine if combining tiotropium with the other inhaled medicines is more effective than using them separately. There is evidence that mucolytics and prophylactic antibiotics reduce exacerbations, but there is uncertainty how these treatments should be used. Both influenza and pneumococcal vaccination are recommended in guidelines, although evidence for the latter remains controversial. Other interventions including oral bacterial extracts and self-management programmes warrant further study.
Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand. pn.black@auckland.ac.nz
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D000208:Acute Disease; D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria; D001993:Bronchodilator Agents / Q000627:therapeutic use; D005100:Expectorants / Q000627:therapeutic use; D006801:Humans; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012602:Scopolamine Derivatives / Q000627:therapeutic use; D000069447:Tiotropium Bromide; D014611:Vaccination / Q000379:methods
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents; D005100:Expectorants; D010726:Phosphodiesterase Inhibitors; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide