Inhaled corticosteroids (ICS) are first-line therapy for asthma and are also commonly used in the treatment of chronic obstructive pulmonary disease (COPD), in particular for those patients with moderate–severe disease and frequent exacerbations. They are preferred to oral corticosteroids because of a lower risk of systemic adverse effects, although high doses of ICS have been reported to be associated with adrenal suppression, glaucoma, osteoporosis, cataracts, pneumonia, bruising and decreased growth in children.
Oral corticosteroids increase the risk of diabetes mellitus and worsen glucose control in patients already diagnosed with the disease. Case reports have linked high doses of ICS with loss of glucose control, but a randomised controlled trial in patients with mild-moderate COPD (n= 1116) did not find an increased risk of diabetes associated with ICS use. The small number of subjects in this trial is a major limitation.
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The 2009 RGH E-Bulletins are archived here.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
asthma,
COPD,
corticosteroids,
diabetes,
RGH E-bulletin
β-blockers have been shown to have several beneficial effects in cardiovascular disease and therefore are used for a variety of indications such as post-myocardial infarction, congestive heart failure, hypertension, angina and arrhythmias.
Despite these benefits, β-blockers are often under-prescribed in COPD patients due to belief that they can precipitate respiratory deterioration or cause bronchospasm. This E-bulletin aims to summarise some of the existing evidence on using β-blockers in COPD patients.
A Cochrane Review conducted in 2008 included 20 randomised control trials showed that cardio-selective β-blockers produced no change in FEV1 or respiratory symptoms compared to placebo, even in patients with severe COPD or for those with a reversible obstructive component. This review concluded that cardio-selective β-blockers should not be routinely withheld from patients with COPD. It should however be noted that the studies included in this review were generally small and of short duration (11 involved single doses), some were single blinded only and some did not include a placebo group.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
Beta blockers,
congestive heart failure,
COPD,
RGH E-bulletin
Patients affected by Chronic Obstructive Pulmonary Disease (COPD) experience chronic symptoms and exacerbations with reduced quality of life despite treatment. Current treatment options for COPD include inhaled short-acting and longacting bronchodilators (either β2-agonists and/or anticholinergic drugs).
Inhaled corticosteroids are added to reduce frequent exacerbations but, among other side effects, there is concern about increased pneumonia risk when inhaled corticosteroids are used in COPD.
Phosphodiesterases (PDE) are the superfamily of enzymes that inactivate the intracellular second messengers cAMP and cGAMP. The known enzymes in the family have different tissue distribution and substrate specificity, and hence are targets for drug design and research. A range of specific PDE isoenzymes have been studied in a range of diseases, notably, erectile dysfunction.
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The 2009 RGH E-Bulletins are archived here.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
Tagged as:
COPD,
Phosphodiesterase,
Phosphodiesterase 4 inhibitors,
RGH E-bulletin
The Australian Lung Foundation has released new guidelines for the management of Chronic Obstructive Pulmonary Disease.
The second paragraph in the Foreword caught my attention:
Smoking is the most important risk factor for COPD. In 2004-05, 24.2% of Australian males and 18.4% of Australian females over the age of 18 years smoked[1]. Smoking-related diseases have increased substantially in women, and death rates from COPD in women are expected to rise accordingly. The death rate from COPD among indigenous Australians is five times that for non-indigenous Australians, and smoking is a leading cause of healthy years lost by indigenous people both in Australia and New Zealand.
The key recommendations are summarised in the “COPDX Plan”:
- Confirm diagnosis
- Optimise function
- Prevent deterioration
- Develop a self-management plan and manage
- eXacerbations
See page 10 of the guidelines for a summary of the COPDX guidelines. If you didn’t click on the link above this link will take you to the Lung Foundation Guidelines (pdf).
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
Tagged as:
COPD,
guidelines,
Lung Foundation
