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Prevention of exacerbations of COPD with pharmacotherapy

M. Miravitlles
European Respiratory Review 2010 19: 119-126; DOI: 10.1183/09059180.00002810
M. Miravitlles
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Tables

  • Table. 1—

    Strategies aimed at preventing exacerbations

    Proven efficacy
        Smoking cessation
        LABAs: salmeterol, formoterol
        Tiotropium
        Combination therapy: LABA/ICS
        Anti-influenza vaccine
        Antipneumococcal vaccine#
        Rehabilitation
        Physical exercise
        Self-management plans
        LVRS in selected patients
    Questioned efficacy
        Theophyllines
        Prophylactic antibiotic in selected patients
        Immunomodulators
        Mucolytic agents
        Antioxidants
    • LABA: long-acting β2-agonist; ICS: inhaled corticosteroid; LVRS: lung volume reduction surgery. #: efficacy demonstrated in prevention of pneumonia but not in the prevention of exacerbations.

  • Table. 2—

    Reduction in exacerbations with pharmacotherapy in selected clinical trials

    First author [Ref.]DrugDoseTrial durationReduction in exacerbations %
    Seemungal [28]Erythromycin250 mg every 12 h1 yr35
    Sethi [32]Moxifloxacin400 mg·day−1 for 5 days every 2 months1 yr25 (46#)
    Calverley [40]Fluticasone500 μg every 12 h3 yrs18
    Kardos [60]Fluticasone500 μg every 12 h1 yr35¶
    Szafranski [38]Budesonide320 μg every 12 h1 yr15
    Calverley [40]Salmeterol50 μg every 12 h3 yr15
    Stockley [76]Salmeterol50 μg every 12 h1 yr30
    Dusser [45]Tiotropium18 μg·day−11 yr27
    Barr [46]Tiotropium18 μg·day−14 yrs14+
    Hubbard [59]BFC320 μg every 12 h1 yr25
    Calverley [40]FSC500/50 μg every 12 h3 yrs25
    Ferguson [63]FSC250/50 μg every 12 h1 yr30.5
    Zheng [69]Carbocysteine1500 mg·day−11 yr25%
    Decramer [68]NAC600 mg·day−13 yrs1 (21§)
    • BFC: budesonide/formoterol combination; FSC: fluticasone/salmeterol combination; NAC: N-acetylcysteine. #: in patients with purulent or mucopurulent sputum at baseline; ¶: not compared with placebo, but with salmetrol alone in patients with forced expiratory volume in 1 s <50% pred; +: not compared with placebo, but with control group of usual medication; §: results in patients not treated with inhaled corticosteroids. As an example, a reduction in 25% means that in patients with 4 exacerbations per year, the frequency would reduce to 3 episodes per year.

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Prevention of exacerbations of COPD with pharmacotherapy
M. Miravitlles
European Respiratory Review Jun 2010, 19 (116) 119-126; DOI: 10.1183/09059180.00002810

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Prevention of exacerbations of COPD with pharmacotherapy
M. Miravitlles
European Respiratory Review Jun 2010, 19 (116) 119-126; DOI: 10.1183/09059180.00002810
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  • Article
    • Abstract
    • DEFINITION AND FREQUENCY OF EXACERBATIONS
    • PHARMACOLOGICAL PREVENTION OF EXACERBATIONS
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