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Comprehensive management of chronic obstructive pulmonary disease (COPD) includes proper assessment, monitoring of disease, reduction of risk factors, the management of stable COPD, and the prevention and management of exacerbations. The 2007 COPD guidelines from the Global Initiative for Chronic Obstructive Lung Disease address each of these aspects of COPD management in detail and provide evidence-based recommendations for patients and health-care professionals. Reduction of risk factors emphasizes the importance of smoking cessation and control of environmental indoor and outdoor pollutants. The management of COPD must be individualized. Aerosol administration of bronchodilators is the most effective method of reducing the work of breathing and alleviating dyspnea. Glucocorticosteroid therapy is recommended to reduce the frequency of exacerbations and improve health-related quality of life for patients with stage 3 and 4 COPD. Pulmonary rehabilitation proves effective in relieving symptoms, improving quality of life, and increasing patients' physical and emotional participation in activities of daily life. Oxygen therapy is essential for patients with substantial hypoxia. Patients with COPD and respiratory failure may benefit from noninvasive ventilation. Surgery may play a limited role in the management of selected patients with COPD. Since exacerbations influence lung function and clinical decline in patients with COPD and contribute to the cost of caring for this disease, efforts must be directed at prevention and management of exacerbations. In addition to controlled oxygen therapy, antimicrobials, brief courses of systemic corticosteroids and, on occasion, noninvasive or invasive mechanical ventilation may play a role. The role of respiratory therapists in the prevention, diagnosis, and management of stable COPD and exacerbations is absolutely essential if the goals of the 2007 Global Initiative for Chronic Obstructive Lung Disease guidelines are to be attained. [ABSTRACT FROM AUTHOR]

Summary: Background: COPD is a prevalent disease that generates high use of resources. The objective of this study was to quantify the economic consequences of non-adherence to GOLD guidelines for the management of COPD patients. Method: An economic model was generated to compare different scenarios of observed vs. expected costs of COPD treatment. A pooled analysis of data derived from a systematic review of studies describing treatment of COPD in Spain was combined with drug costs (using different assumptions) to obtain the observed cost of COPD treatment. An expected cost was obtained with the minimum and maximum treatment intensity derived from the GOLD recommendations. Results: A total of 8 studies were identified, comprising 6339 patients. Average medication cost of COPD patients was estimated as being between €1218 and €1314 per patient per year, higher than the ideal expected average cost (between €1007 and €1021 per patient/year). Thus, implementation of guidelines would result in a mean reduction of €198–€293 per patient/year. Sensitivity analysis showed that about 13% of patients had higher treatment costs than the maximum expected cost. This proportion is much higher in moderately/severely affected patients than in mildly affected patients (28.0% and 11.1%, respectively). Conclusions: Treatment of COPD allows for the identification of areas of inefficiency. An improvement in the adherence to the GOLD guidelines would imply potential savings of medication costs of about 20% of the observed costs. [Copyright &y& Elsevier]

Objective: To educate pharmacists about the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) guidelines for treatment of chronic obstructive pulmonary disease (COPD), newly approved medications, and recent developments since the guidelines were published. Summary: The evidence-base GOLD guidelines provide recommendations for clinicians managing patients with COPD. These guidelines were revised most recently in 2013. Three new medications (indacaterol maleate, aclidinium bromide, and fluticasone furoate/vilanterol) have been approved in the previous 2 years. Adding to the armamentarium of medications for treating COPD is useful. Studies also have been conducted to determine which inhaled agents are preferred for use when long-acting bronchodilators are needed as mono- and combination therapy. In addition, 3-hydroxy-3-methylglutaryl-coenzyme A re-ductase inhibitors and macrolides are being studied for use in COPD. An extensive COPD pipeline consists of many oral and inhaled medications, including olodaterol and glycopyrronium maleate, which are in Phase III clinical trials. Medication adherence is a very important piece of COPD management. Pharmacists play an integral role in drug selection and patient education to ensure the best possible outcomes. Conclusion: The GOLD guidelines represent the standard of care for COPD management. New drug approvals and recent research may affect practitioner choices in managing the disease. Pharmacists can improve medication adherence and selection in order to maximize therapeutic effectiveness and ensure that patients are using inhalation delivery devices optimally. [ABSTRACT FROM AUTHOR]