Incorporating New Evidence on Inhaled Medications in COPD. The Latin American Chest Association (ALAT) 2019
Por:
Montes de Oca M., López Varela M.V., Acuña A., Schiavi E., Casas A., Tokumoto A., Torres Duque C.A., Ramírez-Venegas A., García G., Camelier A., Bergna M., Cohen M., Sanchez-Angarita E., Guzmán S., Czischke K., Barros M., Rey A.
Publicada:
1 ene 2020
Categoría:
Pulmonary and respiratory medicine
Resumen:
This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting ß2-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of <300 cells/µl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD. © 2019 SEPAR
Filiaciones:
Montes de Oca M.:
Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
López Varela M.V.:
Universidad de la República, Hospital Maciel, Montevideo, Uruguay
Acuña A.:
Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
Departamento de Investigación y Estadística, ITSalud/Medsolid, Caracas, Venezuela
Schiavi E.:
SubSecretaría de Planificación Sanitaria, Ministerio de Salud, Gobierno de la Ciudad Autónoma de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Casas A.:
Fundación Neumológica Colombiana, Bogotá, Colombia
Tokumoto A.:
Hospital Central Fuerza Aérea del Perú, Lima, Peru
Torres Duque C.A.:
SubSecretaría de Planificación Sanitaria, Ministerio de Salud, Gobierno de la Ciudad Autónoma de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
Ramírez-Venegas A.:
Instituto Nacional de Enfermedades Respiratorias, Ciudad de Mexico, Mexico
García G.:
Hospital Rodolfo Rossi, La Plata, Argentina
Camelier A.:
Universidade do Estado da Bahia e Escola Bahiana de Medicina, Salvador, Brazil
Bergna M.:
Hospital Dr. Antonio Cetrángolo, Vicente López, Buenos Aires, Argentina
Cohen M.:
Hospital Centro Médico, Guatemala, Guatemala
Sanchez-Angarita E.:
Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
Departamento de Investigación y Estadística, ITSalud/Medsolid, Caracas, Venezuela
Guzmán S.:
Hospital José Gregorio Hernández, Caracas, Venezuela
Czischke K.:
Clínica Alemana de Santiago, Hospital Padre Hurtado, Universidad del Desarrollo, San Ramón, Región Metropolitana, Chile
Barros M.:
Escuela de Medicina, Universidad de Valparaíso, Hospital C. Van Buren, Valparaíso, Región de Valparaíso, Chile
Rey A.:
Universidad de la República, Hospital Maciel, Montevideo, Uruguay
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