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Published in Henry J. Woodford, Essential Geriatrics, 2022
Adherence can be intentional or unintentional (see page 56). Poor adherence or poor inhaler technique leads to more COPD exacerbations. Adherence in clinical practice is lower than that seen in clinical trials. As with other medications, adherence tends to fall when drugs need to be taken more frequently.49 For inhaled COPD therapies, adherence was found to reduce from 43% for once-daily dosing to 23% for drugs taken four times daily.50 A study of people with COPD (mean age 66) found medication adherence to range between 25-68% depending on drug type and disease severity.51 Adherence was better for LAMA drugs and people with more severe disease.
Cholinergic Antagonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Vishal S. Gulecha, Manoj S. Mahajan, Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Ipratropium is used as an inhalational drug in the management of asthma and COPD. It is administered as aerosol due to advantages such as maximal concentration reaches the bronchial target tissue with reduced risk of systemic effects. Another antimuscarinic agent, tiotropium, has better bronchodilator action than ipratropium. Tiotropium is administered once in a daily basis. This drug is shown to reduce the severity COPD exacerbations. It is also used to increase exercise tolerance (Sharma and Sharma, 2017).
Inhaled therapeutics in chronic obstructive pulmonary disease
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Tejas Sinha, Paul Dejulio, Philip Diaz
Increased airway inflammation is central to COPD pathogenesis (5). As such, inhaled corticosteroids, which target a number of inflammatory pathways, are commonly prescribed. However, while ICS agents are considered first-line controller therapy in asthma patients, they are not indicated for all COPD patients (1). For most COPD patients, maintenance bronchodilator regimens should be prioritized prior to initiation of ICS therapy (1). Nevertheless, nearly 40%–50% patients with COPD are prescribed ICS therapy (52). Subgroups of COPD patients felt to benefit from ICS-containing regimens in COPD include those with COPD/asthma overlap syndrome as well as those with two or more acute exacerbations of disease (1). Multiple studies have demonstrated the efficacy of inhaled corticosteroids in preventing acute COPD exacerbations (10). Notably, when prescribed for COPD, ICS should be used in conjunction with LABA as combination ICS/LABA therapy is superior to ICS monotherapy for COPD (1).
Comparation of predictive value of CAT and change in CAT in the short term for future exacerbation of chronic obstructive pulmonary disease
Published in Annals of Medicine, 2022
Ling Lin, Qing Song, Wei Cheng, Cong Liu, Yi-Yang Zhao, Jia-Xi Duan, Jing Li, Dan Liu, Xin Li, Yan Chen, Shan Cai, Ping Chen
To the best of our knowledge, this is the first prospective, observational study to compare the predictive value of the baseline CAT score and the change in CAT for future exacerbation. COPD exacerbation is one of the important events in the disease progression of COPD patients. A study showed that severe exacerbation is an independent risk factor for death [19]. Therefore, it is necessary to assess the risk of exacerbations. Recent research has shown that a history of exacerbations in the previous year was associated with a higher risk of future exacerbation [7,20]. This result is consistent with our research, in which patients with exacerbations in the past year were more likely to experience exacerbations during the one-year follow-up compared to those without a history of exacerbation. Besides, the study showed that history of exacerbation was one of the independent risk factors for future exacerbation on the multivariate Cox model.
Understanding the relationships between environmental factors and exacerbations of COPD
Published in Expert Review of Respiratory Medicine, 2021
Alicia V Gayle, Jennifer K Quint, Elaine I Fuertes
There is heterogeneity in COPD clinical manifestations, outcomes, and responses to treatment. These differences can be used to classify COPD exacerbations into specific phenotypes that can be used to guide therapeutic decisions; for example, bacterial, viral, inflammatory (eosinophilic). Up to two-thirds of COPD exacerbations involve bacterial or viral respiratory infections and, despite resolution of the infection, have a sustained effect on health status. The most frequent bacterial pathogens involved in exacerbations are Streptococcus pneumoniae, non‐typeable haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus and Pseudomonas aeruginosa. Viral infections are one of the most important risk factors for exacerbations, being responsible for up to 50% of COPD exacerbations during all seasons. The most common viruses associated with exacerbations are rhinovirus, influenza A, respiratory syncytial virus and parainfluenza [6–8].
Human rhinovirus infection and COPD: role in exacerbations and potential for therapeutic targets
Published in Expert Review of Respiratory Medicine, 2020
John Cafferkey, James Andrew Coultas, Patrick Mallia
COPD is the fourth leading cause of death worldwide and is increasing in prevalence due to continued exposure to risk factors and an aging population. The clinical course of COPD is characterized by a stable state, interspersed with periods of acute worsening of symptoms that are termed ‘acute exacerbations’. COPD exacerbations are a major cause of morbidity, mortality and healthcare costs and therefore prevention of exacerbations has become a major treatment goal in COPD. Current treatments for COPD exacerbations are targeted at inflammation and bacterial infection and are not very effective. It is now accepted that the most common cause of COPD exacerbations is respiratory virus infection with human rhinoviruses the most common virus type. However the recognition of the role of viruses in triggering COPD exacerbations has not translated into new treatments and therefore this remains a major unmet clinical need. Antiviral drugs have potential as treatments for virus-induced exacerbations but as yet have not been tested in clinical trials.