Towards Rational Prescription of Common Inhaler Medication in the Multimorbid COPD Patient.
Ioanna TsiligianniKristian Jong HoeinesChristian JensenJanwillem W H KocksBjörn StällbergClaudia VicenteRudi PechéPublished in: International journal of chronic obstructive pulmonary disease (2021)
COPD is a chronic disease, typically accompanied by multiple comorbid conditions. The need to apply several, and sometimes conflicting, disease-specific treatment guidelines, complicates the management of individual patients. Moreover, national and international recommendations evolve rapidly but provide limited guidance on the integrated approach in the multimorbid patient. Particularly bothersome is the fact that the presence of comorbidities may deteriorate the course of COPD, and inversely COPD may affect the outcome of the comorbid diseases. In addition, some effects of commonly prescribed COPD inhaler medications, including beta2-agonists, long-acting antimuscarinics and especially inhaled corticosteroids, mimic or worsen COPD-related comorbidities. Therefore, the authors combined their perspectives to formulate advice that may help physicians to improve COPD patient care in daily practice when comorbidities are present. Diabetes, atrial fibrillation, osteoporosis/fractures, infections (pneumonia and tuberculosis) and asthma were identified as areas where practicing clinicians should give special attention to the risk-benefit ratio of the inhaled medication. Overall, the presence of multimorbidity in a COPD patient should act as a signal to carefully reconsider the treatment choices.
Keyphrases
- chronic obstructive pulmonary disease
- lung function
- cystic fibrosis
- healthcare
- atrial fibrillation
- case report
- air pollution
- end stage renal disease
- heart failure
- ejection fraction
- chronic kidney disease
- emergency department
- mycobacterium tuberculosis
- body composition
- hiv aids
- pulmonary tuberculosis
- hiv infected
- peritoneal dialysis
- prognostic factors
- skeletal muscle
- human immunodeficiency virus
- replacement therapy
- venous thromboembolism
- mechanical ventilation
- combination therapy
- smoking cessation
- patient reported