![]() ![]() They are usually used first in mild COPD. Short-acting agents can relieve dyspnea symptoms and improve quality of life. ![]() The initial approach to COPD therapy ( Table 1) is bronchodilation, achieved through the use of short- or long-acting muscarinic (anticholinergic) antagonists or β-agonists. Instead, the goals of therapy are to improve symptoms and quality of life, and prevent exacerbations and hospitalizations. 4, 5 Regrettably, no medication has been shown to slow the progression of COPD. Smoking cessation remains one of the most important aspects of management, reducing the risk of mortality in COPD patients by 40%, and slowing the decline in lung function by the same amount. Spirometry remains the criterion standard for diagnosis the threshold is a postbronchodilator ratio of FEV 1 to forced vital capacity less than 0.7. Suspicion of COPD should be high in individuals older than 40 years of age with respiratory symptoms (eg, coughing, dyspnea, sputum) and at least 1 risk factor (eg, smoking, occupational exposure to lung irritants). is typical of many people with COPD in that his diagnosis is made years after onset of symptoms. Current medications are 20 mg of omeprazole daily and 500 mg of acetaminophen occasionally taken for joint pain.īringing evidence on initial treatment to practice His medical history includes a diagnosis of gastroesophageal reflux disease. You make a diagnosis of moderately severe COPD based on the spirometry result, smoking history, and his symptoms. has a ratio of forced expiratory volume in the first second of expiration (FEV 1) to forced vital capacity of 0.62 and an FEV 1 of 68% of the predicted value with no substantial bronchodilator effect. Upon reviewing the spirometry results, you note that Mr B.Z. has smoked an average of 2 packs of cigarettes per day since the age of 15 (86 pack-years). In the past 2 weeks he has used the salbutamol about 4 times daily with minimal relief of dyspnea. Recently he has only been able to walk for 5 to 10 minutes before needing to stop to catch his breath. Today, further history reveals dyspnea on exertion and an associated cough he has had production of yellowish sputum every morning for the past few years. He was given a prescription for a salbutamol inhaler and sent for spirometry testing. He seldom sees a physician, but 2 weeks ago he presented to the clinic with shortness of breath. Mr B.Z., a 58-year-old married plumber, has an appointment with you today to review his spirometry results. Here we attempt to unravel some of the uncertainties regarding these products: their similarities, differences, advantages, and disadvantages. Numerous new medications and devices for treating COPD have recently arrived on the Canadian market. ![]() 3 Almost half (45%) of Canadians with COPD report their overall health to be “fair or poor,” while 21% report that breathing problems affect their life “quite a bit or extremely.” 1 It is ranked as the fifth-leading cause of death in Canada. 1, 2 Chronic obstructive pulmonary disease increases mortality and has a negative effect on quality of life. About 4% of Canadians older than 35 years have been diagnosed with the disease, although this likely underestimates the true prevalence. Chronic obstructive pulmonary disease (COPD) is common and pernicious. ![]()
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