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Add-on Non-Biologic Therapies in COPD MARCINIUK
Add-on Non-Biologic Therapies in COPD MARCINIUK
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The document details a 2024 COPD Master Class led by Dr. Darcy D. Marciniuk, focusing on add-on oral therapies for Chronic Obstructive Pulmonary Disease (COPD). It emphasizes the exploration of various non-biologic therapies, including antibiotics, PDE-4 inhibitors, mucolytics, theophylline, prednisone, vitamin D, and simvastatin, as potential treatments. <br /><br />The significant issue of acute exacerbations of COPD (AECOPD) is highlighted, noting their impact in worsening lung function and increasing healthcare utilization and mortality. It discusses studies like those by Albert RK, et al., and Uzun S, et al., which investigate the efficacy of azithromycin in reducing the frequency of AECOPD in patients, revealing benefits in prolonging time to exacerbations and improving life quality but with potential side effects like hearing decrements.<br /><br />A Cochrane review suggests that prolonged use of macrolides can be beneficial, though antibiotic resistance was not assessed. Guidelines recommend azithromycin maintenance in suitable patients with caveats about potential risks like microbial resistance and cardiac complications.<br /><br />The document also covers the effectiveness of Roflumilast, a PDE-4 inhibitor, in improving lung function and reducing AECOPD frequency, albeit noting significant adverse reactions such as diarrhea and weight loss. Mucolytics are also suggested for specific patient groups.<br /><br />The CTS guideline advises adding Roflumilast or N-Acetylcysteine for patients not adequately managed by current standard triple therapy (LAMA/LABA/ICS), while cautioning against theophylline and systemic corticosteroids due to limited benefit and potential harm.<br /><br />In summary, the document underscores the nuanced balance between efficacy and risk in selecting add-on therapies for COPD, advocating a tailored approach guided by patient characteristics and clinical assessments.
Keywords
COPD
Chronic Obstructive Pulmonary Disease
oral therapies
non-biologic treatments
acute exacerbations
azithromycin
PDE-4 inhibitors
Roflumilast
mucolytics
antibiotic resistance
personalized treatment
COPD
Chronic Obstructive Pulmonary Disease
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American College of Chest Physicians
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