The latest update of the Australian and New Zealand guidelines for the management of COPD has highlighted the problems arising from the plethora of different inhaler devices on the market.
The TSANZ and Lung Foundation Australia COPD-X guidelines have for the first time recommended that clinicians minimise the number of different devices prescribed for their patients.
The recommendation is based on evidence that ‘inhaler device poly-pharmacy’ has a negative impact on patient outcomes.
On the flip side, patients using devices requiring a similar technique – such as all metered dose inhalers – had fewer exacerbations and used less reliever medications than patients prescribed a mix of different devices.
Chair of the COPD guidelines committee Professor Ian Yang told the limbic the goal of minimising the number of different inhaler devices was important and achievable.
“Inhaler device technique and adherence remain critical issues for the quality use of medicines in COPD,” he said.
The guidelines also reinforce the importance of regularly checking inhaler technique and suggested prescribing the cheapest device that patients can manage.
In another change to the guidelines, evidence supporting the use of high dose N-acetylcysteine has been included.
“N-acetylcysteine has been tested in a number of randomised controlled trials, and now reviewed in this meta-analysis,” Professor Yang said.
“The data from the RCTs and meta-analysis would seem to indicate that patients with moderate to severe COPD who are frequent exacerbators, and possibly chronic bronchitis, may benefit from reduced exacerbations.”
An extensive revision of the nutrition section of the guidelines included discussion on the potential benefits of weight loss for the increasing number of obese patients with COPD. However they concluded more research was necessary.
“Achieving optimal weight is a goal for all patients who have a chronic disease, especially in COPD, which is highly heterogeneous and has varied phenotypes and endotypes,” Professor Yang said.
There was also some evidence included in the guidelines for the use of vitamin E and vitamin D supplementation.
The guidelines also include new evidence that 16% of patients admitted to hospital for COPD exacerbations actually had a pulmonary embolus.
“This systematic review demonstrates that clinicians should not forget PE as a potential cause of worsened breathlessness or chest pain in patients with COPD, especially those without obvious symptoms of a respiratory infection causing the exacerbation,” Professor Yang said.