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TUESDAY, June 2, 2020 (HealthDay News) — In an American Thoracic Society clinical practice guideline, published in the May 1 issue of the American Journal of Respiratory and Critical Care Medicine<\/i>, recommendations are presented for the pharmacologic management of patients with chronic obstructive pulmonary disease (COPD) complaining of exercise intolerance or dyspnea.<\/p>\n
Linda Nici, M.D., and colleagues on the American Thoracic Society Assembly on Clinical Problems, synthesized evidence based on a review of all relevant studies that addressed the clinical questions and critical patient-centered outcomes. Specifically, the panel addressed six emerging questions around COPD management that were not covered in the 2011 guideline on the diagnosis and management of COPD.<\/p>\n
The panel’s recommendations are as follows: (1) for the use of long-acting \u03b22-agonist (LABA)\/long-acting muscarinic antagonist (LAMA) combination therapy over LABA or LAMA monotherapy in patients with COPD and dyspnea or exercise intolerance (strong recommendation); (2) for the use of triple therapy with inhaled corticosteroids (ICS)\/LABA\/LAMA over dual therapy with LABA\/LAMA in patients with COPD and dyspnea or exercise intolerance who have experienced one or more exacerbations in the past year (a conditional recommendation); (3) for ICS withdrawal for patients with COPD receiving triple therapy (ICS\/LABA\/LAMA) if the patient has had no exacerbations in the past year (conditional recommendation); (4) not for or against ICS as an additive therapy to long-acting bronchodilators in patients with COPD and blood eosinophilia, except for those patients with a history of one or more exacerbations in the past year requiring antibiotics or oral steroids or hospitalization, for whom ICS should be an additive therapy (conditional recommendation); (5) against maintenance oral corticosteroids in patients with COPD and a history of severe and frequent exacerbations (conditional recommendation); and (6) for opioid-based therapy in patients with COPD who experience advanced refractory dyspnea despite otherwise optimal therapy (conditional recommendation).<\/p>\n
“The panel’s priority was to formulate questions that were of significant clinical importance to both health care providers and patients,” Nici said in a statement.<\/p>\n
Several authors disclosed financial ties to the pharmaceutical and medical device industries.<\/p>\n