20 Sept 2023 • The revised guidelines 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.

KEY POINTS:

• All symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy

• Comprehensive Clinical Evaluation: Beyond spirometry, a thorough clinical evaluation should assess symptom burden and exacerbation risk. This evaluation allows for evidence-based pharmacologic and nonpharmacologic interventions.

• Moderate to Severe Dyspnea and Impaired Health Status: Patients with moderate to severe dyspnea (modified Medical Research Council ≥ 2) and/or impaired health status (COPD Assessment Test ≥ 10) should receive combination therapy with a long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA).

• High Exacerbation Risk: Patients with moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/inhaled corticosteroids).

• Additional Options: Azithromycin, roflumilast, or N-acetylcysteine are recommended for specific patient populations. The study advises against the use of theophylline, maintenance systemic oral corticosteroids like prednisone, and inhaled corticosteroid monotherapy for all COPD patients.

Source: CHEST | Read full story