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.] Drug Dose Trial duration Reduction in exacerbations % Seemungal [28] Erythromycin 250 mg every 12 h 1 yr 35 Sethi [32] Moxifloxacin 400 mg·day−1 for 5 days every 2 months 1 yr 25 (46#) Calverley [40] Fluticasone 500 μg every 12 h 3 yrs 18 Kardos [60] Fluticasone 500 μg every 12 h 1 yr 35¶ Szafranski [38] Budesonide 320 μg every 12 h 1 yr 15 Calverley [40] Salmeterol 50 μg every 12 h 3 yr 15 Stockley [76] Salmeterol 50 μg every 12 h 1 yr 30 Dusser [45] Tiotropium 18 μg·day−1 1 yr 27 Barr [46] Tiotropium 18 μg·day−1 4 yrs 14+ Hubbard [59] BFC 320 μg every 12 h 1 yr 25 Calverley [40] FSC 500/50 μg every 12 h 3 yrs 25 Ferguson [63] FSC 250/50 μg every 12 h 1 yr 30.5 Zheng [69] Carbocysteine 1500 mg·day−1 1 yr 25% Decramer [68] NAC 600 mg·day−1 3 yrs 1 (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.
