The American journal of medicine
-
Review
Optimizing treatment of chronic obstructive pulmonary disease: an assessment of current therapies.
Bronchodilators are the mainstay of chronic obstructive pulmonary disease (COPD) therapy. Inhaled short-acting beta2-agonists generally have a more rapid onset of effect and shorter duration of action than short-acting anticholinergic agents, and are usually prescribed as "rescue" medication to relieve acute bronchospasm. For patients with persistent symptoms, maintenance therapy with inhaled long-acting beta2-agonists is preferable to short-acting beta2-agonists because long-acting beta2-agonists provide more predictable, longer-lasting improvements in lung function. ⋯ Combining different classes of bronchodilators or combining a bronchodilator with a corticosteroid provides greater improvements in lung function and symptoms than the individual agents given alone. Nonpharmacologic interventions, including pulmonary rehabilitation, oxygen therapy, and surgery, can benefit patients at various stages of disease. A treatment algorithm that combines both pharmacologic and nonpharmacologic interventions for the management of COPD is presented.
-
Early use of beta-blockers is a quality indicator for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI), despite limited data from randomized clinical trials in this population. We sought to determine the impact of acute beta-blocker therapy on outcomes in patients with NSTEMI. ⋯ The majority of NSTEMI patients receive acute beta-blocker therapy. Certain patient subgroups remain undertreated. Because treatment with acute beta-blockers was associated with improved clinical outcomes in nearly all patient subgroups assessed, broader use in patients with NSTEMI appears warranted.
-
The aim of this study was to observe how chronic obstructive pulmonary disease (COPD) is diagnosed and treated in primary care settings and to identify best practices. Researchers interviewed or visited physicians and staff at 25 primary care practices across the United States, focusing on small practices. All interviewers used a standard interview tool to capture anecdotal and quantitative data. ⋯ Practice inefficiencies are responsible for many clinical shortcomings in COPD management. Although improving clinical understanding is important, it is equally important that overburdened and rushed primary care practices optimize workflow. This can be accomplished through better use of support staff and improved scheduling of spirometry testing in order to implement clinical guidelines without interfering with other essential practice tasks.