GOLD guidance: Global Initiative for Chronic Obstructive Lung Disease (GOLD 2008) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. European Respiratory Journal 23(6): 932–46. Stage 4 – Very severe (or FEV1 below 50% with respiratory failure)ĪTS/ERS guidance: Celli BR, MacNee W (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Long-acting 2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are recommended as initial maintenance treatments for COPD, with their combination (LABA-LAMA) advocated as the disease progresses. NICE guideline CG101 (2010) severity of airflow obstruction (post-broncho-dilator) In the network meta-analysis, LAMA/LABA inhalers decreased the rate of moderate to severe exacerbations compared to ICS/LABA (HR 0.86, 95 credible interval (CrI) 0.76 to 0.99), LAMA (HR 0. GOLD 2008 severity of airflow obstruction (post-broncho-dilator) A network meta-analysis was undertaken for dual combination inhalers compared with single-agent long-acting bronchodilators ( Oba 2018) evidence level I. NICE guideline CG12 (2004) severity of airflow obstructionĪTS/ERS 2004 severity of airflow obstruction (post-broncho-dilator) Table 4 Gradation of severity of airflow obstruction LAMA+LABA+ICS vs LAMA+LABA11 Effect of adding ICS to tiotropium + LABA 1 RCT, N293 Exacerbations: number of people with one or more NS LAMA+LABA 65 per 100 vs triple 60 per 100 12 months OR 0.81, 95CI 0.51-1.30 S Ungraded 1 RCT, N293 Mortality (all cause) OR 1.02, 95CI 0.32-3. Transfer factor for carbon monoxide (TLCO) To assess for alpha-1 antitrypsin deficiency if early onset, minimal smoking history or family history However, the same trials have reported mixed results regarding pneumonia. To assess suitability for lung volume reduction procedures Findings In this systematic review and meta-analysis that included 20 randomized clinical trials and 11 894 patients, triple therapy (ICS, LABA, and LAMA), compared with dual therapy (ICS plus LABA), was significantly associated with fewer severe asthma exacerbations (risk ratio, 0. Indeed, trials have shown that combined LAMA-LABA treatment prevents COPD exacerbations more effectively than does ICS-LABA treatment. To investigate abnormalities seen on a chest X-ray (LAMA/LABA) and inhaled corticosteroid/bronchodilator combination (ICS/LABA). To investigate signs that may suggest another lung diagnosis (such as fibrosis or bronchiectasis) The current PBS prescribing rules and levels for dual bronchodilator combination. To investigate symptoms that seem disproportionate to the spirometric impairment To assess cardiac status if cardiac disease or pulmonary hypertension are suspected See the NICE guideline on chronic heart failure in adults for recommendations on using serum natriuretic peptides to diagnose heart failure. A history of cardiovascular disease, hypertension or hypoxia orĬlinical signs such as tachycardia, oedema, cyanosis or features of cor pulmonale

Lama laba ics combination inhaler