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Ebook ABC of COPD (2/E): Part 2

Part 2 book “ABC of COPD” has contents: Pharmacological management – Inhaled treatment, pharmacological management - oral treatment, oxygen, exacerbations, non-invasive ventilation, primary care, future treatments. | CHAPTER 7 Pharmacological Management (I) – Inhaled Treatment Graeme P. Currie1 and Brian J. Lipworth2 1 2 Aberdeen Royal Infirmary, Aberdeen, UK Asthma and Allergy Research Group, Ninewells Hospital and Medical School, Dundee, UK OVERVIEW • All patients with chronic obstructive pulmonary disease (COPD) should use a short-acting bronchodilator (short-acting β2 -agonist or short-acting anticholinergic) for as required relief of symptoms • A long-acting bronchodilator (long-acting anticholinergic or long-acting β2 -agonist) should be started in those with persistent symptoms and exacerbations if the FEV1 is ≥50% of predicted • Inhaled corticosteroids play no role as monotherapy in COPD • A long acting β2 -agonist plus inhaled corticosteroid or long acting anticholinergic should be considered in patients with persistent symptoms and exacerbations who have an FEV1 13,000 individuals, long-term inhaled corticosteroids failed to reduce the decline in FEV1 and no beneficial effects upon mortality were observed. Treatment was, however, associated with reductions in the mean rate of exacerbations per year and rate of decline in quality of life. The dose of inhaled corticosteroid required to achieve maximal beneficial effect with minimal adverse effect (optimum therapeutic ratio) is uncertain. Current evidence Mean change from baseline FEV1 (L) Pharmacological Management (I) – Inhaled Treatment 35 0 –0.05 –0.10 –0.15 –0.20 Budesonide Placebo –0.25 0 3 6 9 12 15 19 21 24 27 30 33 36 Time (months) Figure 7.3 Inhaled corticosteroids have not been shown to influence the rate in decline in lung function in chronic obstructive pulmonary disease (COPD). In this study of patients with mild COPD, no difference in mean change in baseline forced expiratory volume in 1 second (FEV1 ) between placebo and budesonide was observed over 36 months. Reproduced with permission from Vestbo et al. Lancet 1999; 353: 1819–1823. Figure 7.4 Oropharyngeal candidiasis in a .