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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.
Afiliação
  • Bourbeau J; Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada. Electronic address: jean.bourbeau@mcgill.ca.
  • Bhutani M; Department of Medicine, University of Alberta, Edmonton, AB, Canada.
  • Hernandez P; Department of Medicine, Dalhousie University, Halifax, NS, Canada.
  • Aaron SD; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
  • Beauchesne MF; Department of Pharmacy, Université de Montréal, Montréal, QC, Canada.
  • Kermelly SB; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
  • D'Urzo A; Primary Care Lung Clinic, University of Toronto, Toronto, ON, Canada.
  • Lal A; Canadian Thoracic Society, Ottawa, ON, Canada.
  • Maltais F; Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada.
  • Marciniuk JD; Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada.
  • Mulpuru S; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
  • Penz E; Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada.
  • Sin DD; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
  • Van Dam A; Canadian Thoracic Society, Ottawa, ON, Canada.
  • Wald J; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Walker BL; Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Marciniuk DD; Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada.
Chest ; 164(5): 1159-1183, 2023 11.
Article em En | MEDLINE | ID: mdl-37690008
Chronic obstructive pulmonary disease patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacologic and nonpharmacologic interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacologic therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for three questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations, and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥ 2) and/or impaired health status (COPD Assessment Test ≥ 10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/inhaled corticosteroids) azithromycin, roflumilast or N-acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and inhaled corticosteroid monotherapy is made for all COPD patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença Pulmonar Obstrutiva Crônica / Agonistas de Receptores Adrenérgicos beta 2 Tipo de estudo: Guideline / Systematic_reviews Aspecto: Patient_preference Limite: Humans País/Região como assunto: America do norte Idioma: En Revista: Chest Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença Pulmonar Obstrutiva Crônica / Agonistas de Receptores Adrenérgicos beta 2 Tipo de estudo: Guideline / Systematic_reviews Aspecto: Patient_preference Limite: Humans País/Região como assunto: America do norte Idioma: En Revista: Chest Ano de publicação: 2023 Tipo de documento: Article