BASIC SUBJECTSMCI/FMGE/NEET-PGREVIEW SERIES

Download DAMS ANATOMY PG/FMGE HANDWRITTEN NOTES PDF [UPDATED LINK]

Download DAMS ANATOMY PG/FMGE HANDWRITTEN NOTES PDF [UPDATED LINK]

Download DAMS ANATOMY PG/FMGE HANDWRITTEN NOTES PDF [UPDATED LINK]

Dear freemedworld subscribers as you all requested we have made some changes and uploaded into new drive now hopefully all of you cam download without any issues ..please remeber us in your prayers.

Hopefully following will help you to review your COPD management

The management of COPD.

1.Management of stable COPD
2.Management of infection
3.Oxygen therapy
4.Venesection
5.Diuretics
6.Other non-drug treatment

NICE have suggested that inhaled steroids should be used in a combination inhaler as an option if FEV1 <50% in people with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as required (1).

The outline for use of inhaled therapies in the management of stable COPD has been outlined (1):

Short-acting beta2 agonists (SABA) and short-acting muscarinic antagonists (SAMA)
short-acting bronchodilators, as necessary, should be the initial empirical treatment for the relief of breathlessness and exercise limitation

Offer once-daily long-acting muscarinic antagonist (LAMA) in preference to four-times-daily short-acting muscarinic antagonist (SAMA) to people with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as required, and in whom a decision has been made to commence regular maintenance bronchodilator therapy with a muscarinic antagonist.

In people with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as required, offer the following as maintenance therapy:

if FEV1 >= 50% predicted: either long-acting beta2 agonist (LABA) or LAMA

if FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA
in people with stable COPD and an FEV1 >=50%

Who remain breathless or have exacerbations despite maintenance therapy with a LABA:
Consider LABA+ICS in a combination inhaler
consider LAMA in addition to LABA where ICS is declined or not tolerated.

Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS, irrespective of their FEV1

Consider LABA+ICS in a combination inhaler in addition to LAMA for people with stable COPD who remain breathless or have exacerbations despite maintenance therapy with LAMA irrespective of their FEV1

NOTES:

Oral steroids in COPD (2):
there is no evidence to support the long-term use of oral steroids at doses less than 10-15 mg.

Potentially harmful adverse effects e.g.. diabetes, hypertension, osteoporosis would prevent recommending long-term use at these high doses in most patients.

There is some evidence that higher doses (>/= 30 mg prednisolone) improve lung function over a short period.

Inhaled salmeterol plus fluticasone (50/500mcg) (3,4):
the use of combination treatment of inhaled salmeterol plus fluticasone has been investigated in the TORCH study.

TORCH study (TOwards a Revolution in Chronic obstructive pulmonary disease [COPD] Health)
randomised double-blind study in 6,112 patients with COPD
compared the effects of inhaled salmeterol plus fluticasone (50/500mcg) with placebo, salmeterol (50mcg) alone or fluticasone (500mcg) alone
primary outcome was death from any cause for the comparison between the combination regimen and placebo.

After three years, the proportion of deaths in the combination treatment group was not statistically significantly lower than in the placebo group (12.6% vs. 15.2%, respectively; hazard ratio 0.83, 95%CI 0.68 to 1.00, P=0.052)

Combination therapy did significantly reduce the annual rate of exacerbations but, importantly, not the rate of severe exacerbations requiring hospitalisation, compared with salmeterol.

Pneumonia occurred more frequently in the combination and fluticasone groups, than in the salmeterol and placebo groups (19% vs. 13%) – means that, for every 17 people treated for three years with an inhaler containing fluticasone, instead of salmeterol alone or placebo, one suffered pneumonia.

This information is presented to you by:

Dr. Maqsood Ali
MBBS, MRCGP, DTCD, FCCP

REFERENCES:

Walters J et al. Oral corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005;(3):CD005374.
Calverley PMA et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease

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