Episode 27: COPD: Breathing Life into Effective (& some not) COPD Treatments
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In episode 27, we examine the management of COPD Exacerbation and adjunctive treatments. We review the relatively good evidence for antibiotics and steroids in Exacerbations including the options in choice, dosing, and mode of administration. We briefly examination some of the other treatment options in chronic COPD with combination puffers, immunizations, theophyline, and home oxygen.
Comments
Great show! I am a physician
Great show! I am a physician assistant student at the University of Washington School of Medicine (MEDEX)- and Im almost done thank God! Prior to school I was a paramedic in New York City for 13 years. Working the inner city area we saw quite a bit of asthma and COPD. One thing I do not recall hearing about that intrigues me is the use of leukotriene receptor agonists esp. Monteluast given the fact that it can be dosed orally once a day. What do you think about this approach in prophylactic management? Also it seems that British Columbia is considering a role for physician assistants. Do you know anything about this or where to find out more information?
Kind Regards,
Matthew
Hi Matthew - I appreciate the
Hi Matthew - I appreciate the positive feedback. For COPD I couldn't really find any convincing evidence for the use of leukotriene inhibitors - just a couple of small studies suggesting a change in FEV1 - clinical relevance?
For asthma, we haven't done a podcast on that topic yet but my understanding of the evidence is as follows - most studies show them to be less effective than low to medium dose inhaled corticosteroids, but do show benefit in some patients (it's hard to find data to quantify "some") when added to inhaled corticosteroids in patients who don't get adequate control with inhaled steroids - although leukotriene antagonists are not as effective as adding a LABA . There is a Cochrane review on this topic which gives lots of useful information. Check it out.
The "nice" thing about these drugs is that apparently most evidence suggests that if you are going to see an effect, it happens within a couple of days and there isn't much after that - therefore it wouldn't take long to do a trial of these agents in an individual patient.
Sorry but I know very little about the role of physician assistants here in BC. Hopefully someone else will read your post and leave a comment. Thanks again.
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