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LEE SCHREIBER from Doctor Unite, Vincent Gimino Commented on a Post
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Share your Opinion: LAMA for COPD via SMI

Long-acting muscarinic antagonist (LAMA) monotherapy is recommended as first-line therapy for chronic obstructive pulmonary disease (COPD) per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups B, C, and D.

The first LAMA to be approved for COPD was tiotropium bromide. It is administered once daily due to its long duration of action. At first, this medication was delivered by a dry-powder inhaler (DPI) in the form of an inhalation powder. Now, it is available as an inhalation spray delivered via a soft mist inhaler (SMI). The SMI minimizes the necessity for strong inspiratory airflow, which is an issue with DPIs.

Short- and long-term clinical trials suggest that tiotropium bromide is safe and effective, and when compared with placebo/active comparators, improves lung function, health-related quality of life, and exercise endurance, as well as decreasing dyspnea, lung hyperinflation, exacerbations, and need for rescue medication compared.

Discussion questions: Which of your patients best respond to tiotropium bromide? How has treatment improved with the introduction of inhalation spray delivered by SMI?

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  • from Doctor Unite August 18, 2022
    Best to use daily as directed, but some patients do not use correctly
  • August 18, 2022
    LAMA, including tiotropium, are a standard maintenance for the vast majority of COPD patients and part of step up therapy for uncontrolled asthma patients. The SMI does offer a Show More
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Risk Assessment of Acute Myocardial Infarction and Stroke Associated with Long-Acting Muscarinic Antagonists, Alone or in Combination, versus Long-Acting beta2-Agonists

The long-acting muscarinic antagonist (LAMA) aclidinium was approved in Europe in 2012 to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). A post-authorization safety study was initiated ..... see more

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356604/


Conclusion: Risks of AMI, stroke, and MACE in current users of aclidinium, aclidinium/formoterol, tiotropium, other LAMA, LAMA/LABA, or LABA/ICS were similar to the risks among current users of LABA.

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Effectiveness of Tiotropium/Olodaterol in the Real World: A Post Hoc Subgroup Analysis After the First Year of Use - Advances in Therapy

Introduction Real-world evidence is needed to optimize pharmacotherapy for chronic obstructive pulmonary disease (COPD). The effectiveness of inhaled tiotropium/olodaterol according to baseline symptoms and previous COPD treatment and predictors of ..... see more

Source : https://link.springer.com/article/10.1007/s12325-022-02268-1



Conclusions: Tiotropium/olodaterol improved symptoms and lung function in Japanese COPD patients. Our results support the possible use of tiotropium/olodaterol in treatment-naive patients and those with total CAT scores ≥ 10.

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Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting - Cost Effectiveness and Resource Allocation

Background We evaluate the cost-effectiveness of the 'Best Care' integrated disease management (IDM) program for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease (COPD) compared to usual care ..... see more

Source : https://resource-allocation.biomedcentral.com/articles/10.1186/s12962-022-00377-w



Conclusions: This study demonstrates that the IDM intervention for patients with COPD in a primary care setting is cost-effective in comparison to the standard of care. By demonstrating the cost-effectiveness of IDM, we confirm that investment in the delivery of evidence based best practices in primary care delivers better patient outcomes...

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Effectiveness comparison of inpatient vs. outpatient pulmonary rehabilitation: a systematic review - BMC Health Services Research

Background Pulmonary rehabilitation (PR) is the cornerstone of nonpharmacological treatments in chronic respiratory disease (CRD) management. PR can be performed in different settings, the most frequent of which are inpatient ..... see more

Source : https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08345-z



Conclusion: With the current state of knowledge, the majority of the studies converge towards an absence of differences between inPR and outPR or in favor of inPR for seven out of eight outcomes, albeit with moderate, limited, or conflicting evidence. The greater effectiveness of inPR for some outcomes will have to be confirmed in a...

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Comparison of clinical efficacy and satisfaction of Tiotropium via Respimat® administration with and without a spacer in patient with Chronic Obstructive Pulmonary Disease: A single centre experience - PubMed

1 Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Department of Medicine, Respiratory Unit, Malaysia. [email protected] 2 Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Department of Medicine, Respiratory Unit, Malaysia. Free article Free ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35902939/



Conclusion: There was no difference between exacerbation and hospital admissions between both groups. There was no difference in FEV1, CAT and SQRQ score using Tiotropium via Respimat® with or without a spacer.

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Digital spacer data driven COPD inhaler adherence education: The OUTERSPACE proof-of-concept study

To overcome challenges in actuation-breathe coordination, pressurized metered dose inhalers (pMDIs) are recommended to be combined with a spacer device [ , , ]. However, inhalers and spacer devices only ..... see more

Source : https://www.resmedjournal.com/article/S0954-6111(22)00205-0/fulltext



Relevance: Pressurized metered dose inhalers are recommended to be used in combination with spacers, yet inhaler technique and adherence are poor. A novel digital "smart" spacer can record spacer use and technique errors and could facilitate personalized education. In this proof-of-concept study, we assessed the usability of the digital...

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Comparative Efficacy of Umeclidinium/Vilanterol Versus Other Bronchodilators for the Treatment of Chronic Obstructive Pulmonary Disease: A Network Meta-Analysis - Advances in Therapy

Introduction Few randomised controlled trials (RCTs) have directly compared long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) dual maintenance therapies for patients with chronic obstructive pulmonary disease (COPD). This systematic literature review and ..... see more

Source : https://link.springer.com/article/10.1007/s12325-022-02234-x



Conclusion/Relevance: UMEC/VI provided generally better outcomes compared with LAMA or LABA monotherapies, and consistent improvements in lung function (measured by change from baseline in trough FEV1 at 24 weeks) versus dual therapies. Treatment with UMEC/VI may improve outcomes for symptomatic patients with COPD compared with alternative...

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Physical activity and chronic obstructive pulmonary disease: a scoping review - BMC Pulmonary Medicine

Background Reduced physical activity (PA) was the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease (COPD). This scoping review aimed to map the evidence on the ..... see more

Source : https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-02099-4



Conclusions: Changing PA behavior in patients with COPD requires multidisciplinary collaboration. Future studies need to identify the best instruments to measure physical activity in clinical practice. Future studies should focus on the effects of different types, time and intensity of PA in people with COPD and conduct randomized,...

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Physical activity and chronic obstructive pulmonary disease: a scoping review - BMC Pulmonary Medicine

Background Reduced physical activity (PA) was the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease (COPD). This scoping review aimed to map the evidence on the ..... see more

Source : https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-02099-4

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Preparation and Evaluation of Mucus-Penetrating Inhalable Microparticles of Tiotropium Bromide Containing Sodium Glycocholate - PubMed

doi: 10.3390/pharmaceutics14071409. 1 College of Pharmacy, Chungbuk National University, 194-21, Osongsangmyeong 1-ro, Heungdeok-gu, Cheongju 28160, Korea. 2 College of Pharmacy, Wonkwang University, Iksan 54538, Korea. 3 Department of Pharmaceutical Engineering, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35890304/



Relevance: This study aimed to prepare mucus-penetrating inhalable microparticles for dry powder inhalers and to evaluate their applicability in an asthma-induced rat model.

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Cost-effectiveness of single-inhaler extrafine beclometasone dipropionate/formoterol fumarate/glycopyrronium in patients with uncontrolled asthma in England

In patients with asthma that is uncontrolled by a medium- or high-dose inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA), a maintenance therapy option is the addition of a long-acting muscarinic ..... see more

Source : https://www.resmedjournal.com/article/S0954-6111(22)00199-8/fulltext



Conclusion: Both medium- and high-dose BDP/FF/G were cost-effective vs medium- and high-dose BDP/FF in adults with asthma that was uncontrolled by ICS/LABA. In addition, high-dose BDP/FF/G was a dominating strategy to high-dose BDP/FF tiotropium.

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Effects of Inhaled Corticosteroids on the Innate Immunological Response to Pseudomonas aeruginosa Infection in Patients with COPD - PubMed

Inhaled corticosteroids (ICS) use is associated with an increased risk of Pseudomonas aeruginosa (PA) infection in patients with COPD. We aimed to evaluate the effects of ICS on alveolar macrophages ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35897707/



Relevance: Inhaled corticosteroids (ICS) use is associated with an increased risk of Pseudomonas aeruginosa (PA) infection in patients with COPD. We aimed to evaluate the effects of ICS on alveolar macrophages in response to PA in COPD patients with and without baseline ICS treatment (COPD and COPD ICS, respectively) as well as smoker and...

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Osteoporosis in Patients With Respiratory Diseases

Climate change, environmental pollution, and virus epidemics have sharply increased the number of patients suffering from respiratory diseases in recent years. Prolonged periods of illness and drug use increase the ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fphys.2022.939253/full



Conclusion: The problem of osteoporosis in patients with respiratory diseases needs more attention. In this review, we concluded the characteristics of osteoporosis in some respiratory diseases including COPD, asthma, COVID-19, tuberculosis, and lung cancer. We revealed that hypoxia was the common pathogenesis of osteoporosis secondary to...

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Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis - Advances in Therapy

Introduction Randomized controlled trials (RCTs) comparing triple therapies (inhaled corticosteroid [ICS], long-acting β2-agonist [LABA], and long-acting muscarinic antagonist [LAMA]) for the treatment of chronic obstructive pulmonary disease (COPD) are limited. ..... see more

Source : https://link.springer.com/article/10.1007/s12325-022-02231-0


Conclusion: The findings of this NMA suggest favorable efficacy with single-inhaler triple therapy comprising FF/UMEC/VI. Further analysis is required as additional evidence becomes available.

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Asthma, bronchiectasis, and chronic obstructive pulmonary disease: the Bermuda Triangle of the airways - PubMed

doi: 10.1097/CM9.0000000000002225. Online ahead of print. 1 Pneumology Department, Hospital Universitario y Politécnico la Fe de Valencia, Spain. 2 CIBERES de enfermedades respiratorias, Instituto de salud Carlos III, Madrid, Spain. ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35869863/


Relevance: Although asthma and COPD are well-known diseases for most physicians, bronchiectasis is less known. Bronchiectasis is characterized by the bronchial lumen dilatation due to the progressive destruction of the bronchial wall because of a vicious circle of airway inflammation and chronic infection.

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Objective physical activity level is associated with rectus femoris muscle echo-intensity in patients with chronic obstructive pulmonary disease - PubMed

doi: 10.1111/crj.13528. Online ahead of print. 1 Division of Rehabilitation, Akita University Hospital, Akita City, Japan. 2 Department of Rehabilitation, Akita City Hospital, Akita City, Japan. 3 Department of Physical ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35869592/


Conclusion: The present study showed that PA level was associated with RF-EI in patients with COPD. In addition, RF-CSA was associated with knee extensor force. When assessing skeletal muscle using ultrasonography in patients with COPD, we should also assess EI.

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Comparative Efficacy of Umeclidinium/Vilanterol Versus Other Bronchodilators for the Treatment of Chronic Obstructive Pulmonary Disease: A Network Meta-Analysis - PubMed

UMEC/VI provided generally better outcomes compared with LAMA or LABA monotherapies, and consistent improvements in lung function (measured by change from baseline in trough FEV 1 at 24 weeks) versus ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35857184/


Conclusion: UMEC/VI provided generally better outcomes compared with LAMA or LABA monotherapies, and consistent improvements in lung function (measured by change from baseline in trough FEV1 at 24 weeks) versus dual therapies. Treatment with UMEC/VI may improve outcomes for symptomatic patients with COPD compared with alternative maintenance...

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Predictive modeling of COPD exacerbation rates using baseline risk factors - PubMed

These models predicting rates of moderate/severe exacerbations can be applied to a broad range of patients with COPD in terms of airway obstruction, eosinophil counts, exacerbation history, symptoms, and treatment ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35815359/



Conclusion: These models predicting rates of moderate/severe exacerbations can be applied to a broad range of patients with COPD in terms of airway obstruction, eosinophil counts, exacerbation history, symptoms, and treatment history. Understanding the relative and absolute risks related to these factors may be useful for clinicians in...

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  • July 21, 2022
    Key Points • Source: Therapeutic Advances in Respiratory Disease • Relevance: “These models predicting rates of moderate/severe exacerbations can be applied to a broad range of patients with COPD in terms of Show More
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Health-Related Quality of Life and Daily Physical Activity Level in Patients with COPD- a Cluster Analysis

Abstract Abstract Patients with chronic obstructive pulmonary disease (COPD) may have a limited level of physical activity in daily life (PADL) and health-related quality of life (HRQOL). The interrelationships of ..... see more

Source : https://www.tandfonline.com/doi/full/10.1080/15412555.2022.2071244




Conclusions: To conclude, three phenotypes were found, with one indicating disproportionality between PADL and HRQOL.