A small increase in cardiovascular events has been reported with the regular use of ipratropium in COPD patients.
One large, long-term clinical trial showed no evidence of cardiovascular risk when tiotropium was added to other standard therapies. The exact physiologic benefits of methylxanthines xanthine derivatives, such as theophylline remain unknown. There is limited data on the duration of action for both conventional release and extended release xanthine preparations.
In the studies that have shown efficacy of theophylline in COPD, extended release formulations were used. The routine use of NAC in the management of COPD remains controversial due to conflicting evidence and methodological issues in the trials. Family physicians and nurse practitioners in participating areas may consider contacting the Rapid Access to Consultative Expertise RACE phone line to speak directly with a specialist, including respirologists, or accessing referral services through PathwaysBC.
Refer to the Referral Resources section below. Modify therapeutic goals and management plans as appropriate. Making decisions about the intensity of palliative care is a highly individualized process and requires continuous review as COPD progresses. Once the decision to initiate palliative care is made, the goal of therapy is to manage symptoms, reduce treatment burden, and maximize comfort and quality of life. Assess the need for home oxygen, non-pharmacologic therapies, and pharmacologic options for severe dyspnea e. For more information, refer to BCGuidelines. Diagnostic code: chronic airways obstruction, not elsewhere classified.
The guidelines are intended to give an understanding of a clinical problem, and outline one or more preferred approaches to the investigation and management of the problem. The guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problem.
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Note: We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. BC Guidelines is always looking for knowledgeable practitioners to chair and serve on our working groups. Email BC Guidelines at hlth. Comments will be sent to 'servicebc gov. Enter your email address if you would like a reply:. The information on this form is collected under the authority of Sections 26 c and 27 1 c of the Freedom of Information and Protection of Privacy Act to help us assess and respond to your enquiry.
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Endocrine System. Gastrointestinal System. Geriatric Medicine. Head and Neck. Mental Health. Palliative Care. Preventative Health. Respiratory System. Rheumatological and Musculoskeletal Systems. Urological System. Evaluating inhaler technique is particularly important in patients who are older, frail, or cognitively impaired.
Other alternative diagnoses include: heart failure e. Table 1. Other Pulmonary Function Tests Other pulmonary function tests e. Table 2. Smoking Cessation Promote smoking cessation or reduction even in long-term smokers and avoidance of second-hand smoke.
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For more information on effective pharmacological aids for smoking cessation, refer to the BC Smoking Cessation program website: www2. Pulmonary Rehabilitation and Respiratory Services Moderate to severe COPD patients should be referred to a pulmonary rehabilitation program where available and to community respiratory services. J Manag Care Spec Pharm. Redberg RF, Prasad V.
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Evolocumab in Patients with Cardiovascular Disease. Am J Med. Grady D, Redberg RF. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. Br J Sports Med. Advancing the Needs of Patients in the Trump Era. Update in Cardiology: Evidence Published in Ann Intern Med.
The Medicalization of Common Conditions. Bauchner H, Redberg RF. Notice of Retraction: Sato Y, et al. Arch Intern Med. Overpowering Images. Appropriate Use Criteria Require Data. Charlton B, Redberg RF. J Gen Intern Med. Abramson J, Redberg R.
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Conflicts of Interest. Selective reporting in trials of high risk cardiovascular devices: cross sectional comparison between premarket approval summaries and published reports. The role of post-acute care in variation in the Medicare program. Health Aff Millwood. The prescription is laughter. Reporting research misconduct in the medical literature. Health benefits of sauna bathing. Time for professional societies to be bold and wise. Stress testing in the emergency department: not which test but whether any test should be done.