title: Optimising pharmacological maintenance treatment for COPD in primary care.
abstract: Chronic obstructive pulmonary disease (COPD) is a multi-faceted disease that is a major cause of morbidity and mortality worldwide, and is a significant burden in terms of healthcare resource utilisation and cost. Despite the availability of national and international guidelines, and effective, well-tolerated pharmacological treatments, COPD remains substantially under-diagnosed and under-treated within primary care. As COPD is both preventable and treatable there is an urgent need to raise the awareness and profile of the disease among primary care physicians and patients. Increasing evidence suggests that initiation of long-acting bronchodilator treatment at an early stage can significantly improve the patient's long-term health and quality of life (QoL). Recent large-scale trials in COPD have confirmed the longterm benefits of maintenance treatment with long-acting bronchodilators. A wide range of benefits have been shown in selected patient groups including improved lung function and QoL, reduced exacerbations and, in some studies, delayed disease progression and improved survival. In this review, we consider recent developments in our understanding of COPD, including current and emerging pharmacological treatment options, and identify steps for optimising early diagnosis and pharmacological treatment of COPD within the primary care environment.
authors.affiliation: Respiratory Research Unit, Peninsula Medical School, University of Plymouth, UK. rupert.jones@pms.ac.uk
authors.forename: Rupert
authors.initials: R
authors.lastname: Jones
authors.forename: Anders
authors.initials: A
authors.lastname: Østrem
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D011788:Quality of Life; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D000074606:Smoking Prevention
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents