Early COPD Exacerbation Treatment with Combination of ICS and LABA for Patients Presenting with Mild-to-Moderate Worsening of Dyspnea.

This is a proof of concept study that aims to establish feasibility and safety of a new strategy that includes an action plan for early treatment of acute exacerbations of COPD (AECOPD) with doubling dose of a combination of a long-acting beta2 agonist and an inhaled corticosteroid, and to explore its potential for avoiding the requirement of prednisone and its safety. Thirty-seven COPD outpatients with previous exacerbations were enrolled and followed-up for 12 months. The written action plan included a standing prescription to be used in the event of an AECOPD: Antibiotic, for 5 days (for purulent exacerbations) and doubling a combination of Salmeterol and Fluticasone Propionate for 10 days. The primary outcome was "treatment success" defined as "no need of prednisone within 30 days of the onset." Twenty-seven patients experienced an AECOPD and doubled their combination dose. Among the 27 patients, there were 21 patients (78%) who did not require prednisone, and none of those had cardiovascular events, pneumonia, ER and hospital admissions. We have assessed that an early treatment of AECOPD with doubling the dose of a combination of Salmeterol and Fluticasone Propionate appears to be safe, well-tolerated and adhered to, and results in no requirement of systemic corticosteroid in a large proportion of patients presenting with mild-to-moderate worsening of dyspnea. This trial has the potential to change the approach of treatment of AECOPD and reduce the use of oral corticosteroids.

Early COPD Diagnosis in Family Medicine Practice: How to Implement Spirometry?

Introduction. COPD is often diagnosed at an advanced stage because symptoms go unrecognized. Furthermore, spirometry is often not done. Methods. Study was conducted in diverse family medicine practice settings. Patients were targeted if respiratory symptoms were present. Patients had a spirometry to confirm the presence of airflow obstruction and COPD diagnosis. An evaluation of the process was done to better understand facilitating/limiting factors to the implementation of a primary care based spirometry program. Results. 12 of 19 primary care offices participated. 196 of 246 (80%) patients targeted based on the presence of smoking and respiratory symptoms did not have COPD; 18 (7%) and 32 (13%) had COPD, respectively, GOLD I and ≥II. There was no difference in the type and number of respiratory symptoms between non-COPD and COPD patients. Most of the clinics did not have access to a trained healthcare professional to accomplish spirometry. They agreed that giving access to a trained healthcare professional was the easiest and most reliable way of doing spirometry. Conclusion. Spirometry, a simple test, is recommended in guidelines to make the diagnosis of COPD. The lack of allocated time and training of healthcare professionals makes its implementation challenging in family medicine practices.