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Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management ' ? s E G u s Y G ? T W ? Ž l Ž Ð Ž u ? E | s ? Ž ? ? Ž w w s ? G G Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management E ective Date: February 22, 2017 Scope This guideline provides recommendations for the diagnosis and management of adults aged = 19 years with chronic obstructive pulmonary disease (COPD). Key Recommendations • Use spirometry to con$rm air%ow obstruction in all patients suspected (...) of having COPD. [Amended, 2017] • Promote smoking cessation or reduction (even in long-term smokers) to improve symptom control and slow the progression of COPD, among other bene$ts.  • Refer patients with moderate to severe COPD to pulmonary rehabilitation.  • Implement pharmacologic therapy in a stepwise approach and use the lowest step that achieves optimal control based on the patient’s severity of COPD. [New, 2017] • Develop an exacerbation action plan with the patient for pharmacologic
Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine? Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine? – Clinical Correlations Search Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine? April 12, 2017 6 min read By Christopher V. Cosgriff Peer Reviewed The American College of Physicians (ACP) recommends supplemental long-term oxygen therapy (LTOT) in all patients who have severe resting hypoxemia, defined as a PaO 2 ≤55 mmHg or an SpO 2 ≤88 (...) , and no benefit for all secondary outcomes; the authors noted that the consistency of the null result across all outcomes strengthens their findings. It can thus be concluded from these studies that LTOT provides a mortality benefit in severely hypoxemic patients with COPD, but does not improve mortality in those with mild-to-moderate hypoxemia. These trials do not indicate an optimal target range for supplemental oxygenation. The currently accepted oxygen saturation target of 88%-92% is an attempt to provide
Cardiopulmonary response during whole-body vibration training in patients with severe COPD Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted) were examined on two consecutive (...) uptake after 3 min of squat exercises increased from 339±40 mL·min-1 to 1060±160 mL·min-1 with WBVT and 988±124 mL min-1 without WBV (p=0.093). However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068), heart rate (109±13 bpm versus 110±15 bpm, p=0.513) or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279). Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD
Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD). Three classes of inhaler medications are used to manage chronic obstructive pulmonary disease (COPD): long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and inhaled corticosteroids (ICS). When two classes of medications are required, LAMA plus LABA (LAMA+LABA) and LABA plus ICS (LABA+ICS (...) ) are often selected because these combinations can be administered via a single medication device. The previous Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidance recommended LABA+ICS as the first-line treatment for managing stable COPD in high-risk people of categories C and D. However, the updated GOLD 2017 guidance recommends LAMA+LABA over LABA+ICS.To compare the benefits and harms of LAMA+LABA versus LABA+ICS for treatment of people with stable COPD.We performed an electronic
Community pharmacy COPD services: what do researchers and policy makers need to know? COPD is a leading cause of morbidity and mortality across the world and is responsible for a disproportionate use of health care resources. It is a progressive condition that is largely caused by smoking. Identification of early stage COPD provides an opportunity for interventions, such as smoking cessation, which prevent its progression. Once diagnosed, ongoing support services potentially provide
Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD. Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases (...) and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training) compared with controls (pulmonary rehabilitation only). There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness
Management of severe COPD. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, and the burden of the disorder will continue to increase over the next 20 years despite medical intervention. Apart from smoking cessation, no approach or agent affects the rate of decline in lung function and progression of the disease. Especially in the later phase, COPD is a multicomponent disorder, and various integrated intervention strategies are needed as part
Benefit of hospital pharmacy intervention on the current status of dry powder inhaler technique in patients with asthma and COPD: a study from the Central Development Region, Nepal The majority of patients with asthma and chronic obstructive pulmonary disease (COPD) have been known to perform inhaler technique inadequately. We aimed to evaluate the benefit of hospital pharmacy intervention on the current status of dry powder inhaler (Rotahaler®) technique in such patients and the factors (...) associated with the correct use.A pre-post interventional study was conducted at the outpatient pharmacy in a teaching hospital of the Central Development Region, Nepal, in patients with asthma and COPD currently using a Rotahaler device. Patients' demographics and Rotahaler technique were assessed before intervention. Those who failed to demonstrate the correct technique were educated and trained by the pharmacist, and their technique was reassessed after 2 weeks of intervention. Descriptive statistics
Association Between Statin Medications and COPD-Specific Outcomes: A Real-World Observational Study Disease-modifying drugs are not yet available for the management of chronic obstructive pulmonary disease (COPD). HMG-CoA reductase inhibitors (statins) have anti-inflammatory properties and are therefore being considered for use in the management of COPD.Our objective was to examine the association between statin use and COPD-specific outcomes in a real-world setting.This was a retrospective (...) longitudinal dynamic cohort study that used Medicaid claims data from multiple years (2005-2008) to identify patients with newly diagnosed COPD. Statin therapy was determined from the prescription drug file using National Drug Codes (NDCs). COPD-specific outcomes such as hospitalizations and emergency room and outpatient visits were identified based on a primary diagnosis of COPD. Multivariable logistic regressions with inverse probability treatment weights (IPTWs) were used to examine the relationship
COPD in a Population-Based Sample of Never-Smokers: Interactions among Sex, Gender, and Race This observational epidemiological study investigates sex/gender and racial differences in prevalence of COPD among never-smokers. Data were derived from the 2012 Center for Disease Control's Behavioral Risk Factor Surveillance System. The sample consisted of 129,535 non-Hispanic whites and blacks 50 years of age and older who had never smoked. Descriptive and multivariable analyses were conducted (...) , with the latter using a series of logistic regression models predicting COPD status by sex/gender and race, adjusting for age, height, socioeconomic position (SEP), number of household members, marital status, and health insurance coverage. Black women have the highest prevalence of COPD (7.0%), followed by white women (5.2%), white men (2.9%), and black men (2.4%). Women have significantly higher odds of COPD than men. When adjusting for SEP, black and white women have comparably higher odds of COPD than
Upper limb exercise training for COPD. People with chronic obstructive pulmonary disease (COPD) often experience difficulty with performing upper limb exercise due to dyspnoea and arm fatigue. Consequently, upper limb exercise training is typically incorporated in pulmonary rehabilitation programmes to improve upper limb exercise capacity; however, the effects of this training on dyspnoea and health-related quality of life (HRQoL) remain unclear.To determine the effects of upper limb training (...) upper limb training (MD 6.0 lifts, 95% CI 0.29 to 11.71 lifts; one study on 17 people).Available data were insufficient to examine the impact of disease severity on any outcome.Evidence from this review indicates that some form of upper limb exercise training when compared to no upper limb training or a sham intervention improves dyspnoea but not HRQoL in people with COPD. The limited number of studies comparing different upper limb training interventions precludes conclusions being made about