Contemporary Management of Chronic Obstructive Pulmonary Disease

Sin, Don D.; McAlister, Finlay A.; Man, S. F. Paul; Anthonisen, N. R.

doi:10.1001/jama.290.17.2301

Cited by 366 publications

(254 citation statements)

References 141 publications

(181 reference statements)

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“…In the TORCH study, fluticasone compared to placebo reduced moderate to severe exacerbations by 18%, but with no significant effect on hospitalisation due to exacerbations of COPD [159]. Most studies indicate that the greatest benefit in terms of exacerbations appears to be in those with the most advanced COPD, as measured by the baseline FEV 1 [160][161][162]. Withdrawal studies also led to an increase in the rate of mild exacerbations and symptoms, and a decrease in health status, with decreases in FEV 1 [161,163,164].…”

Section: Effect Of Ics Alonementioning

confidence: 99%

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Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

119

106

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International audienceInhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). ICS therapy forms the basis for treatment of asthma of all severities, improving asthma control, lung function and preventing exacerbations of disease. Use of ICS has also been established in the treatment of COPD, particularly symptomatic patients, who experience useful gains in quality of life, likely from an improvement in symptoms such as breathlessness and in reduction in exacerbations, and an attenuation of the yearly rate of deterioration in lung function. The addition of long-acting β-agonist (LABA) therapy with ICS increases the efficacy of ICS effects in moderate-to-severe asthma. Thus, a 800 μg daily dose of the ICS budesonide reduced severe exacerbation rates by 49% compared to a low dose of 200 μg daily, and addition of the LABA formoterol to budesonide (800 μg) led to a 63% reduction. In COPD, the effects of ICS are less prominent but there are beneficial effects on the decline in FEV and the rate of exacerbations. A reduction in the rate of decline in FEV of 16 ml/year with a 25% reduction in exacerbation rate has been reported with the salmeterol and fluticasone combination. A non-significant 17.5% reduction in all-cause mortality rate with ICS and LABA is reported. Chronic inflammation is a feature of both asthma and COPD, although there are site and characteristic differences. ICS targets this inflammation although this effect of ICS is less effective in patients with severe asthma and with COPD; however, addition of LABA may potentiate the anti-inflammatory effects of ICS. An important consideration is the presence of corticosteroid insensitivity in these patients. Currently available ICS have variably potent binding activities to specific glucocorticoid receptors, leading to inhibition of gene expression by either binding to DNA and inducing anti-inflammatory genes or by repressing the induction of pro-inflammatory mediators. Local side effects of ICS include oral candidiasis, hoarseness and dysphonia, while systemic side effects, such as easy bruising and reduction in growth velocity or bone mineral densitometry, are usually restricted to doses above maximally recommended doses. Use of LABA alone in patients with asthma increases the risk of asthma-related events including deaths, but this is less observed with the combination of ICS and LABA. Therefore, use of LABA alone is not recommended for asthma therapy. Future progress in ICS development will be characterised by the introduction of ICS with greater efficacy with a limited side-effect profile, and by longer-acting ICS that can be used in combination with once-daily LABAs. Other agents that could improve the efficacy of corticosteroids or reverse corticosteroid insensitivity may be added to ICS. ICS in combination with LABAs will continue to remain the main focus of treatment of airways diseases

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Section: Effect Of Ics Alonementioning

confidence: 99%

“…Ciclesonide may cause fewer local side effects since it is not metabolised into active ciclesonide in the upper airways. Use of high-dose ICS is particularly associated with an increased incidence of oral thrush and dysphonia in COPD [160].…”

Section: Local Side Effectsmentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

119

106

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“…= ambiguous effect, -= downward trend (in over half of the analysed studies), + = upward trend (in over half of the analysed studies), * = the trend is statistically significant Source: author's elaboration on the basis of (Windham et al, 2003;Ferguson & Weinberger, 1998;Moser, 2000;Norris et al, 2002;Philbin, 1999;Renders et al, 2001;Rich, 1999;Badamgarav et al, 2003;McAlister et al, 2001a;McAlister et al, 2001b;Sin et al, 2003;SUTC, 2007;Weingarten et al, 2002).…”

Section: Sutc -*mentioning

confidence: 99%

Approaches to Evaluating Efficiency and Quality of Integrated Health Care: State of the Evidence

Rudawska

2016

Ekonomia I Zarzadzanie

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Economics and ManagementApproaches to evaluating efficiency and quality of integrated health care: state of the evidence Iga Rudawska A B S T R A C T This paper investigates the outcomes of integrated health care model in terms of its economic efficiency and quality. The quality refers to subjective assessments of a patient, measured by a satisfaction indicator, as well as to the health benefits to a patient, measured by health status. A systematic literature review has been applied to study the results of care coordination. The author performed the ordered analysis of existing research evidence, based on peer-reviewed literature available on health science and business databases. The model of integrated health care delivery seemed to have positive effects on the quality of care. This encompasses mainly the quality of life, functional status, health outcomes, and process outcomes. The equal positive impact of integrated health programmes on economic efficiency has not been revealed. Only 15% of the effects reported in the reviews have been significant. The work contributes to the worldwide debate dedicated to the impact of integrated health care programmes. The gathered research evidence concerning positive influence on costs remains unclear. It might require further investigations. The work also revealed some significant gaps that are prevalent in the field of standardized instruments of measurement referring to integration outcomes, including quality and efficiency over time at levels of the system, programme, provider, and patient. K E Y W O R D S integrated health care, performance measurement, quality improvement, cost containment

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“…salmeterol, formoterol) is more convenient than 4-times-daily regimens of traditional short-acting bronchodilators [27]. In clinical studies significant improvements in lung function, exacerbation rates, and health status have been demonstrated with LABAs in moderate to severe COPD [28,29].…”

Section: Treatment Options For Copdmentioning

confidence: 99%

Effective management of COPD in primary care — the role of long-acting beta agonist/inhaled corticosteroid combination therapy

Schayck

Reid

2006

Primary Care Respiratory Journal

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Summary Chronic obstructive pulmonary disease (COPD) is the internationally preferred term for chronic, progressive lung disorders which are characterised by airflow limitation that is not fully reversible. The symptoms of COPD -including breathlessness, cough, excessive sputum production and reduced muscle tone and muscle wasting -reflect the complex pathophysiology of the disease. In order to address these symptoms, treatment regimens should take into account the multiple components that contribute to COPD. Clinical evidence has emerged indicating that, especially in patients with severe COPD, long-acting beta 2 -agonists (LABAs) and inhaled corticosteroids (ICS) result in improvements in symptoms, reduce the frequency and severity of exacerbations, and improve health-related quality of life. This review evaluates the clinical evidence for the potential of LABA/ICS treatment to address the symptoms of COPD and whether combination therapy of this nature adds significant benefit to patients.

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Contemporary Management of Chronic Obstructive Pulmonary Disease

Cited by 366 publications

References 141 publications

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Approaches to Evaluating Efficiency and Quality of Integrated Health Care: State of the Evidence

Effective management of COPD in primary care — the role of long-acting beta agonist/inhaled corticosteroid combination therapy

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