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GPs should have ‘a lower threshold’ for initiating COPD treatment

The study

UK, Canadian and Belgian researchers conducted a review of the literature investigating the treatment of lung hyperinflation in patients with COPD.

The findings

They found that pulmonary rehabilitation was currently the best way to improve quality of life in patients with COPD, improving exercise endurance and reducing dyspnoea. If a formal exercise programme is not available, regular exercise such as walking for 20 minutes per day should be encouraged. Bronchodilators had a positive effect on both resting and dynamic inspiratory capacity, with improvements on dyspnoea scales during exercise demonstrated. In the few published comparisons of long-acting bronchodilators, tiotropium was reported as superior to salmeterol in improving resting lung volumes and exercise endurance, and indacaterol was reported superior to salmeterol for its effect on resting inspiratory capacity.

What does it mean for GPs?

The authors state that ‘it seems logical that the earlier the vicious cycle of inactivity and deconditioning is interrupted, the better the outcome for patients, and there should be a lower threshold for initiating treatments appropriate to the stage of the disease.’

Expert comment

Dr Mike Thomas, GP in Gloucestershire, study lead and research chairman for the International Primary Care Respiratory Group: ‘Lung hyperinflation is a key driver of symptoms and reduced exercise capacity in COPD. Hyperinflation can be improved both by pharmacological and non-drug interventions, resulting in improved symptoms and quality of life, even when there is little or no effect of these interventions on spirometry values such as FEV1. In patients who have high levels of symptoms but well preserved lung function, hyperinflation is a real possibility, and treatments to improve it should be considered early.’

PCRJ 2013, online 21 February



Discover the latest in COPD at Pulse Live - our new two-day annual conference for general practice - when Dr Hilary Pinnock, a GP in Whitstable and member of the International Primary Care Respiratory Group, delivers her session on ‘What’s new in COPD?’. She provides advice on pulmonary rehabilitation and telehealth in COPD.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.





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