COPD patients need more than the right puffers


By Mardi Chapman

24 Nov 2017

The latest update of the COPD-X guidelines continues to reinforce the importance of managing the multiple comorbidities common in patients with COPD.

The September 2017 version of COPD-X and a Guidelines Summary in the MJA highlight the higher mortality from cardiac events than respiratory failure in COPD patients and the need for optimal management.

Despite a paucity of evidence to suggest harm, beta-blockers were still under-utilised in COPD, the update said.

“With careful monitoring, cardioselective beta-blockers can be safely introduced for patients with heart failure and coexisting COPD,” lead author Professor Ian Yang told the limbic.

Professor Yang, from the University of Queensland and the Prince Charles Hospital, added that prevention and treatment of osteoporosis in patients with COPD were also important goals of management.

“COPD inpatients with vertebral compression fractures, indicative of osteoporosis, have more frequent admissions, longer length of hospital stay, and increased mortality in the two years after admission.”

Consistent with the Australian and New Zealand Pulmonary Rehabilitation Guidelines published this year, COPD-X strongly recommends outpatient pulmonary rehabilitation, commencing within two weeks of hospital discharge, for patients admitted due to a COPD exacerbation.

Professor Yang said evidence was also convincing for use of non-invasive ventilation (NIV) in acute hypercapnic respiratory failure due to COPD. He said it should be considered in all patients.

The update also includes more evidence for serum procalcitonin testing although it is not yet funded by Medicare.

“Elevated procalcitonin tends to indicate a bacterial respiratory infection in COPD, and may possibly help to guide whether or not antibiotic therapy should be used. However, the test should not be applied in the presence of pneumonia, as patients with pneumonia were excluded from the COPD exacerbation studies,” Professor Yang said.

The update also included another reference supporting the evidence that chest x-rays alone were not sufficient or accurate enough for the diagnosis of COPD.

“Spirometry is required,” Professor Yang said.

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