In spite of these indications, LABA/ICS inhalers remain the second most commonly prescribed first-line treatments (after LAMA monotherapy) across the range of COPD severities, because its use has been associated with an increased risk of pneumonia. On the other hand, LABA-ICS combinations are indicated for patients with severe-to-very-severe disease and a history of repeated exacerbations. Additionally, they prevent exacerbations and increase exercise endurance by reducing pulmonary hyperinflation and dyspnoea. Use of LABA-LAMA inhalers are crucial to symptom management in COPD, improving lung function and health-related quality of life. However, results for the incidence of severe pneumonia requiring hospitalization were better with LABA-LAMA (HR, 0.66 0.41–1.05), particularly in the on-treatment analysis (HR, 0.66 0.50–0.87). Once Anoro’s foil packaging is open the in-use shelf life is 6 weeks. In multivariable Cox analysis the respective hazard ratios (HRs) for moderate and severe COPD exacerbations associated with LABA-LAMA initiation vs LABA-ICS initiation were 1.04 (95 percent CI, 0.90–1.20) and 0.94 (0.65–1.36). Co-administration of LAMA/LABA combinations with other LAMA, LABA or products containing either of these agents has not been studied and is not recommended. There was no significant difference in the incidence of exacerbations between the two groups. Researchers used data from the United Kingdom’s Clinical Practice Research Datalink and identified 1,977 initiators of LABA-LAMA and 1,977 matched initiators of LABA-ICS.Īll patients were aged ≥55 years and followed for 12 months for the occurrence of a moderate or severe COPD exacerbation and severe pneumonia. GOLD guidance: Global Initiative for Chronic Obstructive Lung Disease (GOLD 2008) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.Long-acting beta 2-agonist (LABA) plus long-acting muscarinic antagonist (LAMA) combinations compare with inhalers containing both LABA and corticosteroid (LABA-ICS) in terms of reducing chronic obstructive pulmonary disease (COPD) exacerbations, although the LAMA-LABA combination is more favourable as it is associated with fewer episodes of severe pneumonia, according to a study. European Respiratory Journal 23(6): 932–46. Stage 4 – Very severe (or FEV1 below 50% with respiratory failure)ĪTS/ERS guidance: Celli BR, MacNee W (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. NICE guideline CG101 (2010) severity of airflow obstruction (post-broncho-dilator) GOLD 2008 severity of airflow obstruction (post-broncho-dilator) NICE guideline CG12 (2004) severity of airflow obstructionĪTS/ERS 2004 severity of airflow obstruction (post-broncho-dilator) Table 4 Gradation of severity of airflow obstruction Transfer factor for carbon monoxide (TLCO) To assess for alpha-1 antitrypsin deficiency if early onset, minimal smoking history or family history To assess suitability for lung volume reduction procedures To investigate abnormalities seen on a chest X-ray To investigate signs that may suggest another lung diagnosis (such as fibrosis or bronchiectasis) To investigate symptoms that seem disproportionate to the spirometric impairment To assess cardiac status if cardiac disease or pulmonary hypertension are suspected See the NICE guideline on chronic heart failure in adults for recommendations on using serum natriuretic peptides to diagnose heart failure. A history of cardiovascular disease, hypertension or hypoxia orĬlinical signs such as tachycardia, oedema, cyanosis or features of cor pulmonale
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