Published November 5, 2020
Manoj J. Mammen, MD, associate professor of medicine in the Division of Pulmonary, Critical Care and Sleep Medicine, is one of the co-authors of new clinical practice guidelines for chronic obstructive pulmonary disease (COPD) issued by the American Thoracic Society.
“Pharmacologic Management of Chronic Obstructive Pulmonary Disease: An Official American Thoracic Society Clinical Practice Guideline,” was published in April in the American Journal of Respiratory and Critical Care Medicine.
“The American Thoracic Society guidelines on the pharmacological treatment for COPD aim to improve quality of life and control symptoms, while reducing the frequency of exacerbation,” Mammen says.
One of the most important distinctions in the new guidelines as to how they differ from previous recommendations is that patients with COPD should be offered both a long-acting beta-agonist (LABA) bronchodilator and a long-acting muscarinic antagonist (LAMA) bronchodilator if still symptomatic with the use of either type of inhaled medication by itself, according to Mammen.
“There is a conditional recommendation to use inhaled corticosteroids (ICS) in patients with dyspnea who are receiving combined LABA/LAMA therapy and experience one or more exacerbations in the past year, but to stop ICS in patients who are on ICS with LABA/LAMA therapy and with stable COPD without frequent exacerbations,” he says.
In patients with COPD who have advanced refractory dyspnea, the guidelines make a conditional suggestion to consider use of opioids in the context of a personalized shared decision-making process with the provider and patient.
The guidelines were focused on pharmacological therapies for stable COPD, not for those who are experiencing an acute exacerbation, Mammen notes.
“In general, the goal of therapy in COPD is to reduce frequency of exacerbation and control symptoms,” he says.
“It is important to note that these recommendations should be applied along with clinical assessment and shared decision-making to ensure that patients receive optimal clinical care.”
The guidelines also call for additional research in populations that are underrepresented in existing clinical trials, including studies in:
The American Thoracic Society improves global health by advancing research, patient care and public health in pulmonary disease, critical illness and sleep disorders.
Founded in 1905 to combat tuberculosis, it has grown to tackle asthma, COPD, lung cancer, sepsis, acute respiratory distress and sleep apnea, among other diseases.