HealthDay News — In an American Thoracic Society clinical practice guideline, published in the American Journal of Respiratory and Critical Care Medicine, recommendations are presented for the pharmacologic management of patients with chronic obstructive pulmonary disease (COPD) complaining of exercise intolerance or dyspnea.
Linda Nici, MD, 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.
The panel’s recommendations are as follows: (1) for the use of long-acting β2-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 1 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 1 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).
“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.
Several authors disclosed financial ties to the pharmaceutical and medical device industries.