2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients With Stable COPD

Bourbeau, Jean; Bhutani, Mohit; Hernandez, Paul; Aaron, Shawn D.; Beauchesne, Marie-France; Kermelly, Sophie B.; D’Urzo, Anthony; Lal, Avtar; Maltais, François; Marciniuk, Jeffrey D.; Mulpuru, Sunita; Penz, Erika; Sin, Don D.; Van Dam, Anne; Wald, Joshua; Walker, Brandie L.; Marciniuk, Darcy D.

doi:10.1016/j.chest.2023.08.014

Cited by 22 publications

(5 citation statements)

References 81 publications

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“…Recommendations by professional organisations, such as GOLD, Canadian Thoracic Society and Spanish Society of Pulmonology and Thoracic Surgery, on the management of COPD, have generally emphasised the need to provide education and training on inhaler device technique to patients and the need to assess a patient's technique before modifying therapy. [29][30][31] But in some guidelines, this consideration is not discussed, 32 and in practice, it is frequently overlooked. 33 A study of patients in nine countries (Brazil, Canada, France, Germany, Italy, Japan, the Netherlands, the UK and the USA) found that 29% had not had their inhaler technique checked by a healthcare professional within the last 2 years.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD

Halpin,

Mahler

2024

BMJ Open Resp Res

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BackgroundErrors using inhaled delivery systems for COPD are common and it is assumed that these lead to worse clinical outcomes. Previous systematic reviews have included patients with both asthma and COPD and much of the evidence related to asthma. More studies in COPD have now been published. Through systematic review, the relationship between errors using inhalers and clinical outcomes in COPD, including the importance of specific errors, was assessed.MethodsElectronic databases were searched on 27 October 2023 to identify cohort, case–control or randomised controlled studies, which included patients with COPD, an objective assessment of inhaler errors and data on at least one outcome of interest (forced expiratory volume in 1 s, (FEV1), dyspnoea, health status and exacerbations). Study quality was assessed using the Newcastle and Ottawa scales. A narrative synthesis of the results was performed as there was insufficient detail in the publications to allow quantitative synthesis. There was no funding for the review.Results19 publications were included (7 cohort and 12 case–control) reporting outcomes on 6487 patients. 15 were considered low quality, and most were confounded by the absence of adherence data. There was weak evidence that lower error rates are associated with better FEV1, symptoms and health status and fewer exacerbations. Only one considered the effects of individual errors and found that only some were related to worse outcomes.ConclusionEvidence about the importance of specific errors using inhalers and outcomes would optimise the education and training of patients with COPD. Prospective studies, including objective monitoring of inhalation technique and adherence, are needed.PROSPERO registration numberCRD42023393120.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD

Halpin,

Mahler

2024

BMJ Open Resp Res

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“…Ideally, an evidence-based approach should be taken when prescribing anticholinergic medication for any condition. Recent meta-analyses, such as those for COPD [ 32 , 33 ] and overactive bladder [ 34 , 35 ], are valuable resources for such information.…”

Section: Adverse Effects Of Anticholinergic Medicationsmentioning

confidence: 99%

An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders

Vanegas-Arroyave,

Caroff,

Citrome

et al. 2024

CNS Drugs

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Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms are drug-induced parkinsonism (DIP), dystonia, akathisia, and tardive dyskinesia (TD). Although rare, neuroleptic malignant syndrome (NMS) is a potentially life-threatening consequence of DRBA exposure. Recommendations for anticholinergic use in patients with DIMDs were developed on the basis of a roundtable discussion with healthcare professionals with extensive expertise in DIMD management, along with a comprehensive literature review. The roundtable agreed that “extrapyramidal symptoms” is a non-specific term that encompasses a range of abnormal movements. As such, it contributes to a misconception that all DIMDs can be treated in the same way, potentially leading to the misuse and overprescribing of anticholinergics. DIMDs are neurobiologically and clinically distinct, with different treatment paradigms and varying levels of evidence for anticholinergic use. Whereas evidence indicates anticholinergics can be effective for DIP and dystonia, they are not recommended for TD, akathisia, or NMS; nor are they supported for preventing DIMDs except in individuals at high risk for acute dystonia. Anticholinergics may induce serious peripheral adverse effects (e.g., urinary retention) and central effects (e.g., impaired cognition), all of which can be highly concerning especially in older adults. Appropriate use of anticholinergics therefore requires careful consideration of the evidence for efficacy (e.g., supportive for DIP but not TD) and the risks for serious adverse events. If used, anticholinergic medications should be prescribed at the lowest effective dose and for limited periods of time. When discontinued, they should be tapered gradually. Graphical Abstract

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“…Surveys conducted in Europe and the USA showed that prevention of mortality was not among the most common reasons cited by pulmonologists and primary care physicians for choice of prescribed maintenance therapy [ 91 , 92 ]. The 2023 GOLD report highlighted that triple therapy is the only pharmacotherapy to reduce mortality in COPD [ 93 ], and the recently released Canadian Thoracic Society Guidelines went one step further by including mortality reduction in the pharmacological treatment algorithm [ 94 ]. However, fundamental change in clinical practice is still needed to ensure prioritisation of cardiopulmonary risk reduction in the management of COPD.…”

Section: Approaches To Cardiopulmonary Risk Management In Copdmentioning

confidence: 99%

Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review

Singh,

Han,

Hawkins

et al. 2024

Adv Ther

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Chronic obstructive pulmonary disease (COPD) constitutes a major global health burden and is the third leading cause of death worldwide. A high proportion of patients with COPD have cardiovascular disease, but there is also evidence that COPD is a risk factor for adverse outcomes in cardiovascular disease. Patients with COPD frequently die of respiratory and cardiovascular causes, yet the identification and management of cardiopulmonary risk remain suboptimal owing to limited awareness and clinical intervention. Acute exacerbations punctuate the progression of COPD in many patients, reducing lung function and increasing the risk of subsequent exacerbations and cardiovascular events that may lead to early death. This narrative review defines and summarises the principles of COPD-associated cardiopulmonary risk, and examines respiratory interventions currently available to modify this risk, as well as providing expert opinion on future approaches to addressing cardiopulmonary risk.

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2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients With Stable COPD

Cited by 22 publications

References 81 publications

Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD

Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD

An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders

Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review

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