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In early 2015, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of the drug combination aclidinium bromide and formoterol for the treatment of COPD when compared with the standard therapies. The following results apply to people with severe COPD (stage 3) with more than one flare-up per year.For this group, the researchers analyzed the data of 56 people participating in three studies conducted by the manufacturer. 34 participants used the fixed combination of aclidinium bromide / formoterol, and 22 used formoterol only. In addition, all participants were given an inhaled steroid.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 4, 2015

People with Chronic obstructive pulmonary disease (COPD) are prone to sudden episodes where their symptoms become worse and oxygen levels may fall. Initial treatment during these episodes usually includes oxygen, but this may cause a rise in the carbon dioxide levels that can be dangerous. This review could not find any evidence to indicate the safest way to provide oxygen treatment in this circumstance.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

In early 2015, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of the drug combination aclidinium bromide and formoterol for the treatment of COPD when compared with the standard therapies. The following results apply to:People with moderate COPD (stage 2)People with severe COPD (stage 3) who have no more than one flare-up per yearThe manufacturer provided three studies involving about 1,100 patients for assessment. The studies compared the fixed combination of aclidinium bromide / formoterol with formoterol monotherapy.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 4, 2015

Usual doses of corticosteroids for two or three years for asthma does not weaken bones in younger patients, although long term outcomes and after high doses need more research.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Some people with advanced chronic lung disease (COPD ‐ chronic bronchitis or emphysema) can experience breathing failure. This involves chemical changes which in turn can lower the drive to breathe. The drug acetazolamide is used for mountain sickness, and it can stimulate breathing in some circumstances. The review of trials found that a few days of using acetazolamide can improve the level of oxygen in the blood of people with COPD. It is not clear if this leads to better outcomes, so more research is needed. Not enough data were reported on the safety of the drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Methylxanthine drugs such as aminophylline and theophylline are recommended for use in patients who have acute exacerbations (episodes) of chronic obstructive pulmonary disease, particularly for patients unresponsive to standard therapies. This review identified four studies that compared these drugs with placebo. Over the first 2 hours of treatment there was no evidence that patients improved in terms of lung function, although a possible late benefit was detected. The studies do not give a clear indication of whether there was benefit in terms of reduced symptoms or hospital admissions, but side effects were found to be more common with methylxanthines. We conclude that, given current evidence, methylxanthines should not be used for acute exacerbations of chronic obstructive pulmonary disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

This review involved the assessment of different inhaler devices for delivery of inhaled bronchodilators in stable chronic obstructive pulmonary disease (COPD). Studies included in this review involved pressurised metered dose inhalers (pMDI) being compared to any other handheld inhaler device containing bronchodilators. Only three randomised controlled trials met the inclusion criteria. Due to the very small number of studies included in this review, it is not possible to draw any conclusions on the use of inhaler devices containing bronchodilators in COPD. There need to be further well designed randomised controlled trials examining the role of bronchodilators in COPD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Long term treatment with beta‐blocker medication reduces the risk of death in patients with high blood pressure, heart failure and coronary artery disease. But patients who have both COPD and cardiovascular disease sometimes do not receive these medicines because of fears that they may worsen the airways disease. This review of data from 22 randomised controlled trials on the use of cardioselective (heart‐specific) beta‐blockers in patients with COPD demonstrated no adverse effect on lung function or respiratory symptoms compared to placebo. This finding was consistent whether patients had severe chronic airways obstruction or a reversible obstructive component. In conclusion, cardioselective beta‐blockers should not be withheld from patients with COPD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Mixtures of helium and oxygen (heliox) may make breathing easier, but there is not enough evidence from trials to show whether these mixtures can relieve attacks of COPD (chronic obstructive pulmonary disease).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Shortness of breath is the main complaint of persons with chronic obstructive pulmonary disease (COPD). This symptom worsens during an exacerbation or 'flare' of COPD. Trials comparing ipratropium bromide versus beta‐agonists showed no significant difference in short‐term or long‐term effects (24 hours) on ease of breathing. Side effects of these drugs were reported by only a minority of patients and include dry mouth and tremor, and a 'strange feeling' after drug administration.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Theophylline treatment is commonly used in people with chronic obstructive pulmonary disease (COPD). This systematic review shows that orally administered theophylline improves lung function and levels of oxygen and carbon dioxide in the blood. However, there is limited data on its effect on symptoms, exercise capacity or quality of life. Despite being associated with increased side effects, particularly nausea, participants preferred theophylline over placebo.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Short‐term studies indicate that people with chronic obstructive pulmonary disease respond to the administration of oxygen when they do exercise tests. Ambulatory oxygen is the use of supplemental oxygen during exercise and activities of daily living. One way to assess if ambulatory oxygen is beneficial for a patient with COPD is to compare the effects of breathing oxygen and breathing air on exercise capacity. Some people with COPD may benefit more than others, and trials should take account of whether people who do not already meet criteria for domiciliary oxygen also respond. This review shows that there is strong evidence that ambulatory oxygen (short‐term) improves exercise capacity. Further research needs to focus on which COPD patients benefit from ambulatory oxygen, how much oxygen should be provided and the long‐term effect of ambulatory oxygen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Some people with advanced COPD (chronic obstructive pulmonary disease) experience respiratory failure whereby blood oxygen levels fall and high levels of the waste gas carbon dioxide accumulate and cause worsening symptoms. In extreme cases this disturbance in the blood can cause coma and death. When respiratory failure is severe giving oxygen alone is no longer enough because an increase in carbon dioxide levels can make the situation worse by depressing the drive to breathe. Doxapram is a drug that may stimulate breathing. The review of trials found that it may be able to help, but some newer treatments may be more effective. Doxapram may be worthwhile as a short‐term measure or when other treatments are not possible.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Some people with chronic lung disease (COPD ‐ chronic bronchitis or emphysema) have low levels of oxygen in their blood. Oxygen levels might be low all the time, or only at night when breathing slows during sleep. Some people use bottled oxygen through the night at home, to try and improve their breathing. The review of trials found that when people with COPD and low levels of blood oxygen did this for the long term, their survival rates improved. However, it did not lengthen survival of people whose oxygen levels were only moderately low, or only low at night.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

During an acute worsening of chronic obstructive pulmonary disease, there may be a worsening in airway function. Two different types of drugs may be given as inhaled therapy to improve this: anticholinergic drugs such as ipratropium and beta2‐agonists. These days the drugs of the latter type that are used for acute COPD are salbutamol and terbutaline, but neither of these drugs have been used in the only studies that we could find. We found only three small studies. Overall, both types of drug showed a small but worthwhile effect. There was no difference between them. Our review was not designed to test whether they would have had a greater effect if both were given at the same time.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Chronic obstructive pulmonary disease (COPD) is a common, progressive lung disorder with mainly non‐reversible limitation of airflow. Corticosteroids improve airflow limitation in asthma and have been tried in COPD. This review found treatment with oral steroids improved lung function and symptoms more than placebo, but not all people benefited equally. Long‐term use did not slow the decline in lung function and there was an increased risk of side‐effects such as diabetes and osteoporosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Patients with COPD (emphysema and chronic bronchitis) are more likely to have anxiety disorders compared with the general population. These symptoms adversely affect various aspects of daily life. Medications are widely used to treat these symptoms but there is little evidence to support this practice. This systematic review of four studies (total of 40 participants) found insufficient evidence of benefit for any of the three classes of medications included in this review. There is a considerable lack of evidence to address pharmacological interventions for anxiety disorders in patients with COPD. We recommend that new research be conducted to ascertain the best mode of treatment for anxiety within this population. This new research needs to be of good methodological design, investigate an adequate number of patients and have a meaningful length of follow‐up.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

People recovering from an exacerbation of COPD have traditionally done so in hospital. We wanted to find out if peoples' recovery could be aided by treating them at home. So called "hospital at home" support is where a person is sent home and looked after by a specialist respiratory nurse under the guidance of a hospital medical team. People receive regular scheduled visits from the nurse as well as additional visits as requested by the patient and these visits continue until the person has made a full recovery and is discharged from care.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

This review looks at studies that compare the regular use for at least four weeks of different types of inhaled short‐acting bronchodilator medication in people with chronic obstructive pulmonary disease (COPD, or emphysema/chronic bronchitis). There were eleven trials included. There were no major differences seen between the responses to ipratropium and salbutamol, or the combination. Where there were benefits, they were small and would not support a general recommendation for the use of ipratropium bromide or a combination with beta‐2 agonist over a beta‐2 agonist alone in COPD. People with COPD could use the short‐acting bronchodilator that gives them the most improvement in their symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Tiotropium (Spiriva) is a bronchodilator drug that has been developed to open the airways in the lungs effectively with once daily dosing. The main aims of therapy in COPD are to reduce exacerbations and related hospitalisations, improve quality of life, and reduce the rate of decline in lung function. The evidence from the trials in the review indicates that, compared with a placebo and ipratropium, tiotropium does reduce exacerbations and related hospitalisations and improves quality of life and symptoms in people with moderately severe COPD, although the evidence with regards to decline in lung function is less clear. Tiotropium caused dry mouth. Compared with other commonly used drugs in COPD, such as long‐acting beta agonists (including salmeterol), there is not enough evidence for us to draw reliable conclusions. In order to better understand the effects of this drug we need long‐term studies (over several years), studies conducted in mild and severe COPD, and additional studies that measure outcomes in relation to other agents used in the treatment of this condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

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