![]() ![]() However, we will await any revision of New Zealand guidelines in accordance with the GOLD 2023 report. Given these significant changes, we plan to update this article. Use of an ICS + LABA alone is now discouraged throughout COPD management unless prescribed for a concurrent diagnosis such as asthma.This supersedes previous guidance to use LAMA or LABA monotherapy first. LABA/LAMA combination treatment is now recommended as the first-line option in patients requiring a long-acting bronchodilator, including those who are more symptomatic or at high exacerbation risk.categories “C” and “D” in the “ABCD” tool are now combined into a single “E” category). This recognises the clinical relevance of exacerbations, regardless of the patient’s symptom severity (i.e. A revised “ABE” assessment tool for predicting patient outcomes and making treatment decisions.It contains a number of updated recommendations, including: However, the College reports notes that only 54% of hospitals offer smoking cessation services.Īn editorial writer suggests that the UK National Health Service needs to do better to provide access to these services.The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released a 2023 report on the prevention, diagnosis and management of COPD. Smoking cessation is known to reduce mortality in COPD patients. However, the College reports notes that only 60% of COPD subjects are enrolled within 90 days of referral and 38% of these did not complete the treatment. Pulmonary rehabilitation, a treatment combining an exercise regimen and education about self-care, is widely acknowledged as an effective and high-value intervention for people with COPD. Recently the Royal College of Physicians has published reports on this matter which are relevant as it is estimated that there are more than a million COPD patients in the UK. Internal Medicine Journal 2018 48:728–31 UK COPD treatment: failing to progress It was concluded that this emphasises the need to assess adherence and try to understand the barriers patients face. There were more hospital admissions among those with very poor adherence (p=0.03). ![]() The mean HbA1c was 70mmol/mol in the good adherent group and 97 in the poorly adherent. Forty-seven percent were found to have good adherence and 21% of the group had very poor adherence. Adherence was assessed by documentation of drugs collected from pharmacies. Information about medication adherence and glycaemic control has been correlated in 266 type 2 diabetics aged between 18 and 39 years. This important matter is reviewed in this paper which reports on data from the Greenlane Diabetes Clinic. N Engl J Med 2018 378:1671–80 Adherence to medication, glycaemic control and hospital attendance in young adults with type 2 diabetes ![]() The results of the trial demonstrated that the triple therapy resulted in a lower rate of moderate or severe COPD exacerbations than either of the other two treatments. Over 10,000 patients were randomised to treatment with the triple therapy or treatment with a LABA-LAMA or steroid-LABA combination. This report is of a trial in which a combination of the three drugs in a single inhaler is used once daily. However, it means that patients have to use multiple inhalers several times per day. Such treatment has shown considerable benefits in several trials. ![]() Triple inhaled therapy for chronic obstructive pulmonary disease (COPD) comprises an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-antagonist (LABA). Once-daily single-inhaler triple versus dual therapy in patients with COPD ![]()
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