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Towards Rational Prescription of Common Inhaler Medication in the Multimorbid COPD Patient
Author(s) -
Ioanna Tsiligianni,
Kristian Jong Hoeines,
Christian Jensen,
Janwillem Kocks,
Björn Ställberg,
Cláudia Vicente,
Rudi Peché
Publication year - 2021
Publication title -
international journal of chronic obstructive pulmonary disease/international journal of copd
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.394
H-Index - 67
eISSN - 1178-2005
pISSN - 1176-9106
DOI - 10.2147/copd.s298345
Subject(s) - medicine , polypharmacy , copd , intensive care medicine , comorbidity , asthma , inhaler , medical prescription , disease , diabetes mellitus , physical therapy , nursing , endocrinology
COPD is a chronic disease, typically accompanied by multiple comorbid conditions. The need to apply several, and sometimes conflicting, disease-specific treatment guidelines, complicates the management of individual patients. Moreover, national and international recommendations evolve rapidly but provide limited guidance on the integrated approach in the multimorbid patient. Particularly bothersome is the fact that the presence of comorbidities may deteriorate the course of COPD, and inversely COPD may affect the outcome of the comorbid diseases. In addition, some effects of commonly prescribed COPD inhaler medications, including beta 2 -agonists, long-acting antimuscarinics and especially inhaled corticosteroids, mimic or worsen COPD-related comorbidities. Therefore, the authors combined their perspectives to formulate advice that may help physicians to improve COPD patient care in daily practice when comorbidities are present. Diabetes, atrial fibrillation, osteoporosis/fractures, infections (pneumonia and tuberculosis) and asthma were identified as areas where practicing clinicians should give special attention to the risk-benefit ratio of the inhaled medication. Overall, the presence of multimorbidity in a COPD patient should act as a signal to carefully reconsider the treatment choices.