Recommendations for the pharmacological treatment of COPD: questions and answers

Abstract

The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.

Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the São Paulo “protocol”

“…Although this information was probably collected from patient self-reports, it might indicate that this group of patients require frequent medical care. We highlight that a Brazilian study published in 2017 (19) pointed to important indicators in COPD patients with exacerbations: in-hospital mortality during exacerbation, 3.6%-11.0%; risk of hospitalization in the year following hospitalization, 23-43%; and calculated fatality (excess mortality compared with stable COPD), 15.6%. This highlights the importance of measures to prevent and treat COPD exacerbations.…”

COPD: more treatment will translate to better breathing. Will it?

“…The current recommendation for COPD treatment is based on an accurate diagnosis and on phenotypic characteristics, especially whether or not the patient is a frequent exacerbator. In a recent review, 3 it was recommended that, in patients with severe dyspnea and a low risk of exacerbation, dual bronchodilator treatment (LABA+LAMA) is indicated. A recent meta-analysis showed that the use of the LABA+LAMA+ICS combination reduced the risk of exacerbation (RR = 0.70; 95% CI: 0.53-0.94) and improved FEV 1 (mean increase, 37.94 mL; 95% CI: 18.83-53.89) when compared with the use of the LABA+LAMA combination 7 .…”

“…Now that we have the new combinations of LABA+LAMA and LABA+LAMA+ICS, tailoring the treatment will be of fundamental importance. It is always important to emphasize that the pharmacological treatment of COPD should be complemented by measures such as smoking cessation, encouraging physical activity, pulmonary rehabilitation, and vaccination 3 . However, all of the new evidence that is being unveiled will have no value if the knowledge is not disseminated.…”

Capacidade Funcional Em Indivíduos Com Doença Pulmonar Obstrutiva Crônica Em Uma Cidade Do Alto Paranaíba-Mg

“…Fernandes et al, 2017;Cruz, 2017).Segundo a ATS/ERS, a reabilitação do DPOC deve ser realizada por uma equipe multidisciplinar composta por médicos, fisioterapeutas, nutricionistas, enfermeiros, psicólogos e o envolvimento familiar. O fisioterapeuta tem por objetivo atuar na prevenção e reabilitação pulmonar, por meio de exercícios físicos e fortalecimentos, minimizando a seriedade dos sintomas da doença.…”