Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroids
International and national guidelines on chronic obstructive pulmonary disease (COPD) emphasise bronchodilators as first-line therapy. However, in considering them the ‘foundation’ of treatment, attention has shifted from the fact that COPD is fundamentally an inflammatory disease. The mainstay ough...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
AOSIS
2020-12-01
|
| Series: | South African Family Practice |
| Subjects: | |
| Online Access: | https://safpj.co.za/index.php/safpj/article/view/5198 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849737566015717376 |
|---|---|
| author | Elvis M. Irusen Thandeka Malange |
| author_facet | Elvis M. Irusen Thandeka Malange |
| author_sort | Elvis M. Irusen |
| collection | DOAJ |
| description | International and national guidelines on chronic obstructive pulmonary disease (COPD) emphasise bronchodilators as first-line therapy. However, in considering them the ‘foundation’ of treatment, attention has shifted from the fact that COPD is fundamentally an inflammatory disease. The mainstay ought to be anti-inflammatory medication, and inhaled corticosteroids (ICS) are the best agents we have presently. There was initial scepticism about their role, but ICS were subsequently shown to have numerous anti-inflammatory effects. They are synergistic with bronchodilators at a molecular and clinical level and unequivocally improve dyspnoea, quality of life, exacerbation frequency and, more recently, mortality. These benefits are most apparent in the COPD eosinophilic phenotype. These beneficial effects have been met with some reservations because of the predisposition to pneumonia of ICS. This must be seen in context: over 90% of COPD patients in all clinical trials do not get pneumonia. The fact that patients with COPD are predisposed to pneumonia because of the disease itself is disregarded; this is a crucial omission as this constitutes the baseline incidence of about 3%. When one allows for this, then in the clinical reports, the excess risk of pneumonia ranges from zero to a maximum of 3%. Equally, some of the systemic effects attributed to ICS fail to appreciate that the disease, smoking and older age are risk factors in themselves, and ICS do not aggravate these. Chronic obstructive pulmonary disease has considerable impact on respiratory reserve and is associated with increasing morbidity; optimal outcomes are best achieved with long-acting bronchodilators and ICS co-prescription. |
| format | Article |
| id | doaj-art-0deee824a81546a0b1b0fe31f6a54880 |
| institution | DOAJ |
| issn | 2078-6190 2078-6204 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Family Practice |
| spelling | doaj-art-0deee824a81546a0b1b0fe31f6a548802025-08-20T03:06:52ZengAOSISSouth African Family Practice2078-61902078-62042020-12-01621e1e610.4102/safp.v62i1.51984096Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroidsElvis M. Irusen0Thandeka Malange1Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Tygerberg Hospital, Cape TownDivision of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape TownInternational and national guidelines on chronic obstructive pulmonary disease (COPD) emphasise bronchodilators as first-line therapy. However, in considering them the ‘foundation’ of treatment, attention has shifted from the fact that COPD is fundamentally an inflammatory disease. The mainstay ought to be anti-inflammatory medication, and inhaled corticosteroids (ICS) are the best agents we have presently. There was initial scepticism about their role, but ICS were subsequently shown to have numerous anti-inflammatory effects. They are synergistic with bronchodilators at a molecular and clinical level and unequivocally improve dyspnoea, quality of life, exacerbation frequency and, more recently, mortality. These benefits are most apparent in the COPD eosinophilic phenotype. These beneficial effects have been met with some reservations because of the predisposition to pneumonia of ICS. This must be seen in context: over 90% of COPD patients in all clinical trials do not get pneumonia. The fact that patients with COPD are predisposed to pneumonia because of the disease itself is disregarded; this is a crucial omission as this constitutes the baseline incidence of about 3%. When one allows for this, then in the clinical reports, the excess risk of pneumonia ranges from zero to a maximum of 3%. Equally, some of the systemic effects attributed to ICS fail to appreciate that the disease, smoking and older age are risk factors in themselves, and ICS do not aggravate these. Chronic obstructive pulmonary disease has considerable impact on respiratory reserve and is associated with increasing morbidity; optimal outcomes are best achieved with long-acting bronchodilators and ICS co-prescription.https://safpj.co.za/index.php/safpj/article/view/5198bronchodilatorschronic obstructive pulmonary diseaseguidelinesinhaled corticosteroidspharmacotherapy |
| spellingShingle | Elvis M. Irusen Thandeka Malange Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroids South African Family Practice bronchodilators chronic obstructive pulmonary disease guidelines inhaled corticosteroids pharmacotherapy |
| title | Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroids |
| title_full | Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroids |
| title_fullStr | Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroids |
| title_full_unstemmed | Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroids |
| title_short | Pharmacotherapy of chronic obstructive pulmonary disease: Therapeutic considerations with a focus on inhaled corticosteroids |
| title_sort | pharmacotherapy of chronic obstructive pulmonary disease therapeutic considerations with a focus on inhaled corticosteroids |
| topic | bronchodilators chronic obstructive pulmonary disease guidelines inhaled corticosteroids pharmacotherapy |
| url | https://safpj.co.za/index.php/safpj/article/view/5198 |
| work_keys_str_mv | AT elvismirusen pharmacotherapyofchronicobstructivepulmonarydiseasetherapeuticconsiderationswithafocusoninhaledcorticosteroids AT thandekamalange pharmacotherapyofchronicobstructivepulmonarydiseasetherapeuticconsiderationswithafocusoninhaledcorticosteroids |