Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease – 2008 Update – Highlights for Primary Care

O’Donnell, Denis E.; Hernández, Paul; Kaplan, Alan; Aaron, Shawn D.; Bourbeau, Jean; Marciniuk, Darcy; Balter, Meyer; Ford, Gordon; Gervais, André; Lacasse, Yves; Maltais, François; Road, Jeremy; Rocker, Graeme; Sin, Don D.; Sinuff, Tasmin; Voduc, Nha

doi:10.1155/2008/641965

Cited by 164 publications

(135 citation statements)

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“…Scores on the palliative performance scale ranged from 50%-70%. All patients had a score of 5 on the Medical Research Council dyspnea scale (i.e., they were too short of breath to leave their homes or were breathless when dressing or undressing), varied in scores for dyspnea intensity, anxiety and depression, were on optimal conventional inhaled COPD therapies as per Canadian Thoracic Society guidelines, 25 were using long-term oxygen therapy, and had been using opioids for dyspnea for five weeks to four years.…”

Section: Patients' Perspectivesmentioning

confidence: 99%

Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease

Rocker¹,

Young²,

Donahue³

et al. 2012

CMAJ

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Background: A recent national practice guideline recommends the use of opioids for the treatment of refractory dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD). We conducted two qualitative studies to explore the experiences of patients and family caregivers with opioids for refractory COPD-related dyspnea and the perspectives and attitudes of physicians toward opioids in this context. Methods: Patients (n = 8; 5 men, 3 women), their caregivers (n = 12; 5 men, 7 women) and physicians (n = 28, 17 men, 11 women) in Nova Scotia participated in the studies. Semistructured interviews were recorded, transcribed verbatim, coded conceptually and analyzed for emergent themes using interpretive description methodology. Results: Patients reported that opioids provided a sense of calm and relief from severe dyspnea. Family caregivers felt that opioids helped patients to breathe more “normally,” observed improvements in patients’ symptoms of anxiety and depression, and experienced reductions in their own stress. Patients reported substantial improvements in their quality of life. All patients and family caregivers wanted opioid therapy to continue. Most physicians were reluctant to prescribe opioids for refractory dyspnea, describing a lack of related knowledge and experience, and fears related to the potential adverse effects and legal censure. Interpretation: Discrepancies between the positive experiences of patients and family caregivers with opioids and the reluctance of physicians to prescribe opioids for refractory dyspnea constitute an important gap in care. Bridging this gap will require initiatives to improve the uptake of practice guidelines and to increase confidence in prescribing opioids for dyspnea refractory to conventional treatment

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Section: Patients' Perspectivesmentioning

confidence: 99%

Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease

Rocker¹,

Young²,

Donahue³

et al. 2012

CMAJ

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“…1,[6][7][8][9] These recommendations are based on a number of small randomized trials, most of which were conducted more than 20 years ago using narrow spectrum antibiotics that are no longer commonly used. 10 Only 4 studies, totaling 321 subjects, included hospitalized patients, and most studies excluded patients who required steroids.…”

mentioning

confidence: 99%

Comparative effectiveness of macrolides and quinolones for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)

Rothberg

Pekow

Lahti

et al. 2010

Journal of Hospital Medicine

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BACKGROUND: Meta‐analyses of randomized trials have found that antibiotics are effective in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but there is insufficient evidence to guide antibiotic selection. Current guidelines offer conflicting recommendations. OBJECTIVE: To compare the effectiveness of macrolides and quinolones for AECOPD DESIGN: Retrospective cohort study using logistic regression, propensity score–matching, and grouped treatment models. SETTING: A total of 375 acute care hospitals throughout the United States. PATIENTS: Age ≥40 years and hospitalized for AECOPD. INTERVENTION: Macrolide or quinolone antibiotic begun in the first 2 hospital days. MEASUREMENTS: Treatment failure (defined as the initiation of mechanical ventilation after hospital day 2, inpatient mortality, or readmission for AECOPD within 30 days), length of stay, and hospital costs. RESULTS: Of the 19,608 patients who met the inclusion criteria, 6139 (31%) were treated initially with a macrolide and 13,469 (69%) with a quinolone. Compared to patients treated initially with a quinolone, those who received macrolides had a lower risk of treatment failure (6.8% vs. 8.1%; P < 0.01), a finding that was attenuated after multivariable adjustment (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.78–1.01), and disappeared in a grouped‐treatment analysis (OR, 1.01; 95% CI, 0.75–1.35). There were no differences in adjusted length of stay (ratio, 0.98; 95% CI, 0.97–1.00) or adjusted cost (ratio, 1.00; 95% CI, 0.99–1.02). After propensity score–matching, antibiotic‐associated diarrhea was more common with quinolones (1.2% vs. 0.6%; P < 0.001). CONCLUSIONS: Macrolide and quinolone antibiotics are associated with similar rates of treatment failure in AECOPD; however, macrolides are less frequently associated with diarrhea. Journal of Hospital Medicine 2010;5:267–267. © 2010 Society of Hospital Medicine.

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“…Since the last published CTS COPD Guidelines in 2007 and 2008, 1,2 key messages regarding disease management remain at the forefront: 1) Use spirometry in targeted populations for case finding of "early" and undiagnosed COPD for prompt intervention (including enhancing effectiveness of smoking cessation interventions); 2) Improve the treatment algorithms by incorporating accurate assessment of dyspnea and activity limitation and; 3) Use strategies to prevent and manage acute exacerbations, particularly in moderate to severe disease.…”

Section: Key Messages From the Last Cts Copd Guideline That Remain Rementioning

confidence: 99%

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: Since the last published Canadian Thoracic Society (CTS) COPD guideline in 2007 and the 2008 update -highlights for primary care, many new clinical trials have challenged COPD treatment practices. The current Canadian position statement provides the reader with an update on pharmacotherapy of patients with COPD as reviewed by the CTS. OBJECTIVES: The objectives of this position statement are: 1) to summarize the literature on topics relevant to the pharmacological therapy of patients with stable COPD; and 2) to provide clinical guidance with evidence-based recommendations and expert-informed key messages for the pharmacological therapy for patients with stable COPD. METHODS: The authors systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert-informed opinion, were agreed upon by a majority consensus. MAIN RESULTS: There is typically a significant delay in seeking medical care by patients with dyspnea, often waiting until symptoms affect the performance of activities of daily living. The diagnosis of COPD requires spirometry to confirm the presence of airflow obstruction in any patient presenting with symptoms and/or risk factors of COPD. An effective management plan for individuals with COPD should include: smoking cessation, vaccination and education. A number of non-pharmacological treatments are available for COPD patients with symptoms to improve outcomes such as self-management with coaching from a health care professional; pulmonary rehabilitation; supplemental oxygen in selected patients; and surgery.Current pharmacotherapy for COPD has been shown to alleviate symptoms and prevent exacerbations and related complications such as hospital admissions. In symptomatic patients with stable COPD not having or having infrequent exacerbation, treatment should be started with inhaled LAMA or LABA monotherapy, and if experiencing persistent or increased dyspnea, exercise intolerance, and/or reduced health status despite use of monotherapy, patients should be considered for treatment "step up" with an inhaled LAMA plus LABA dual therapy. In this situation, the use of a single inhaler would be preferred to simplify the treatment regimen and minimize the cost. In patients with stable COPD experiencing exacerbations despite the use of LAMA or LABA monotherapy, treatment "step up" with inhaled LAMA plus LABA dual therapy should be considered unless a patient has concomitant asthma (Asthma/COPD overlap (ACO)). There has been recent interest in using biomarkers to identify patients who are more likely to respond to ICS. Most of the studies have demonstrated that high blood eosinophils could be valuable to predict an increase response in terms of reduction of exacerbation rate when treated with combination ICS/LABA; there is still uncertainty about the exact cut-off level of blood eosinophils having potential therapeutic value. If a pa...

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Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease – 2008 Update – Highlights for Primary Care

Cited by 164 publications

References 0 publications

Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease

Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease

Comparative effectiveness of macrolides and quinolones for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)

CTS position statement: Pharmacotherapy in patients with COPD—An update

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