Episode 26: COPD: Confusing Overwhelming Puffer Data leaving us Breathless
In episode 26, we examine the initial management of COPD. We first discuss the diagnosis of COPD and if screening is recommended. We encourage an initial focus on smoking cessation and then episodic, symptom control. We then review long acting puffers and the large body of confusing research with underwhelming and at times conflicting results. Unfortunately, the data available for long acting puffers serves as a good example of how more information can exacerbate confusion.
Show Notes
1) Diagnosis data
Ann Intern Med. 2007;147:633-638.
2) Lung decline and smoking
3) Evidence only for symptomatic and FEV<60%
Ann Intern Med 2007;147:639-653
4) Outcomes for puffers in COPD
Ann Intern Med 2007;147:639-653
Tiotropium
NEJM 2007;356:775-89 LABA/steroid
5) Latest tiotropium data
JAMA 2008;300:1439-50 NEJM 2008;359:1543-54
6) Inhaled steroid adverse events
Chest. 2005;127:89-97 NEJM 2000;343:1902-9
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