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Therefore, a primary care-based study investigating treatment evolution in the 24 months after COPD diagnosis may help to identify patterns in progression of therapy, which can be used to create targeted interventions and educational programs. Numerous studies report less than optimal compliance with guidelines in patients with COPD –. Patients starting on LAMA or LABA+ICS would then progress to triple therapy (LABA+LAMA+ICS) if exacerbations or breathlessness persist. If the FEV 1 is <50%, the treatment choice is between a LAMA or LABA+ICS. For patients with FEV 1 ≥ 50%, a LAMA or a LABA is recommended as the initial choice. NICE guidelines in the UK indicate a stepwise progression from bronchodilator monotherapy to a combination therapy based on the level of post-bronchodilator FEV 1 percent predicted. Inhaled corticosteroids (ICSs) are added as anti-inflammatory agents to reduce the rate of exacerbation in patients with severe disease. A combination of LABA and LAMA is prescribed if symptoms persist even after individual bronchodilator monotherapy. Combination therapy produces a greater change in spirometry and symptoms in comparison with monotherapy.
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Long-acting β 2-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs) are also used to reduce the number and severity of exacerbations. Changes in forced expiratory volume in 1 second (FEV 1) following bronchodilator therapy can be small however, the accompanying larger change in lung volume contributes toward reduction in perceived breathlessness. GOLD and NICE guidelines suggest that bronchodilators such as β 2-agonists and antimuscarinics form the mainstay of therapy. As COPD is a progressive condition, daily maintenance drugs are usually needed. Short-acting β 2-agonists (SABAs) are used on an as-needed basis for symptomatic relief in early stages. Once COPD is diagnosed and its severity is established, pharmacological treatment aims to reduce symptoms and exacerbations. International guidelines such as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy and local guidelines such as the National Institute for Health and Care Excellence (NICE) provide guidance to physicians in treating COPD. It remains a major healthcare problem, and various guidelines have been created to aid in effective management of this disease –. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.Ĭhronic obstructive pulmonary disease (COPD) is “a preventable and treatable disease characterized by airflow limitation that is not fully reversible”. The funder provided support in the form of salaries for authors, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: Funding for this study was provided by GlaxoSmithKline and all authors are employees of GlaxoSmithKline. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: Funding for this study was provided by GlaxoSmithKline. Received: JanuAccepted: JPublished: September 2, 2014Ĭopyright: © 2014 Wurst et al. PLoS ONE 9(9):Įditor: Dominik Hartl, University of Tübingen, Germany
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Citation: Wurst KE, Punekar YS, Shukla A (2014) Treatment Evolution after COPD Diagnosis in the UK Primary Care Setting.