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Yves Lacasse

Publications and source records attributed to Yves Lacasse.

At least 19 recordsLinked to original sources
PubMed2006

Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease.

BACKGROUND: The responsiveness of the endurance shuttle walk to functional changes following bronchodilation has recently been reported. The current literature suggests that the 6 min walking test (6MWT) is less responsive to bronchodilation than the endurance shuttle walk. AIM: To compare bronchodilator-induced changes in exercise performance with the 6MWT and the endurance shuttle walk. METHODS: In a randomised, double-blind, placebo-controlled, crossover trial, 14 patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 s (FEV(1)) 50 (8)% predicted) completed two 6MWTs and two endurance shuttle walks, each preceded by nebulised placebo or 500 microg ipratropium bromide. Cardiorespiratory parameters were monitored during each walking test with a portable telemetric gas analyser. Quadriceps twitch force was measured by magnetic stimulation of the femoral nerve before and after each walking test. RESULTS: The 6 min walking distance did not change significantly after bronchodilation despite a significant increase in FEV(1) of 0.18 (0.09) litres (p<0.001). A similar change in FEV(1) (0.18 (0.12) litres, p<0.001) was associated with a significant improvement in the distance walked on the endurance shuttle walk (Deltadistance ipratropium bromide--placebo = 144 (219) m, p = 0.03). Quadriceps muscle fatigue was infrequent (<15% of patients) after both walking tests. CONCLUSION: The endurance shuttle walk is more responsive than the 6MWT for detecting changes in exercise performance following bronchodilation.

Aged↗
PubMed2006

Hypersensitivity pneumonitis.

Hypersensitivity pneumonitis (HP) is a pulmonary disease with symptoms of dyspnea and cough resulting from the inhalation of an antigen to which the subject has been previously sensitized. The incidence of HP is unknown. A population-based study estimated the annual incidence of interstitial lung diseases as 30:100,000 and HP accounted for less than 2% of these cases. The diagnosis of HP can often be made or rejected with confidence, especially in areas of high or low prevalence respectively, using simple diagnostic criteria. Chest X-rays may be normal in active HP; High Resolution Computed Tomography is sensitive but not specific for the diagnosis of HP. The primary use of pulmonary function tests is to determine the physiologic abnormalities and the associated impairment. Despite the pitfalls of false positive and false negatives, antigen-specific IgG antibodies analysis can be useful as supportive evidence for HP. Bronchoalveolar lavage plays an important role in the investigation of patients suspected of having HP. A normal number of lymphocytes rules out all but residual disease. Surgical lung biopsy should be reserved for rare cases with puzzling clinical presentation or for verification the clinical diagnosis when the clinical course or response to therapy is unusual. Being an immune reaction in the lung, the most obvious treatment of HP is avoidance of contact with the offending antigen. Systemic corticosteroids represent the only reliable pharmacologic treatment of HP but do not alter the long-term outcome. The use of inhaled steroids is anecdotal. Treatment of chronic or residual disease is supportive.

Adult↗
PubMed2006

Effect of rollator use on health-related quality of life in individuals with COPD.

OBJECTIVE: The purpose of this study was to evaluate the influence of rollator use on health-related quality of life in patients with COPD. DESIGN: Randomized controlled trial. METHODS: Thirty-one postrehabilitation patients with COPD were randomized to receive a rollator (n = 18) or usual care (n = 13) for 8 weeks and to record the frequency of rollator use. Outcome measures at baseline, 4 weeks, and 8 weeks included the Chronic Respiratory Questionnaire (CRQ) and the 6-min walk (6MW). RESULTS: During acute testing, subjects consistently walked further when assisted (baseline 6MW: 292 +/- 67 m vs 263 +/- 67 m; 8 weeks: 283 +/- 65 m vs 259 +/- 68 m [+/-SD]; p = 0.013). However, provision of a rollator at home was not associated with group differences in the CRQ (p > 0.08) or in the unassisted 6MW (p = 0.4) or the assisted 6MW (p = 0.5). Eight of 18 subjects assigned to the rollator group used the rollator less than three times per week. Regular users demonstrated a consistent improvement in mastery compared with infrequent users (4 weeks: 4.7 +/- 0.6 vs 5.2 +/- 0.8, respectively; 8 weeks: 5.3 +/- 0.8 vs 4.7 +/- 0.4; p = 0.014). CONCLUSIONS: Despite evidence of effectiveness during acute testing, this study did not demonstrate a rollator effect on quality of life or exercise capacity when the rollator was provided at home, for a longer period. Actual use of a rollator may be an important determinant of its effect. Therefore, when prescribing a rollator, health-care professionals should attempt to identify those most likely to use it.

Aged↗
PubMed2006

Health-related quality of life in morbid obesity.

BACKGROUND: In order to evaluate the impact of severe obesity and its treatment on quality of life (QoL), it would be important to first identify the areas of QoL most likely to be affected by the disease. METHODS: We first constructed a list of 187 items potentially related to QoL of patients with morbid obesity. From this list, consecutive candidates for bariatric surgery were asked to identify what they felt were the most significant items and to grade their importance. The item impact was determined from the proportion of patients who identified it as important, and the mean importance score attributed to this item (impact score = frequency X importance). RESULTS: 100 patients (68 female; mean body mass index 51.5 kg/m(2); mean age 42) were interviewed. Overall, the impact of morbid obesity was more important in women than in men. The areas of impairment were very similar in both groups, with the important difference that women ranked their dissatisfaction with physical appearance higher than men. The items having the most important impact on QoL clustered into 7 domains: 1) activity/mobility; 2) symptoms; 3) personal hygiene/clothing; 4) emotions; 5) social interactions; 6) sexual life; and 7) eating behavior. CONCLUSION: The impact of morbid obesity on QoL is not limited to the activity/mobility domain. Morbid obesity contributes to the impairment of all domains of what is usually referred to as "health-related quality of life".

Adult↗
PubMed2005

Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease.

Abnormal heart rate recovery (HRR) after exercise, a marker of cardiac autonomic dysfunction, is associated with poor prognosis in various populations. As chronic obstructive pulmonary disease (COPD) is associated with cardiac autonomic dysfunction, we tested the hypothesis that patients with COPD have a lower HRR than healthy people, and evaluated whether a delay in HRR is associated with an increased risk of mortality in COPD. The records of 147 COPD patients were reviewed (65.1+/-9.1 years, mean+/-sd, 42 women/105 men, forced expiratory volume in 1s (FEV1): 42+/-15% predicted) and compared to 25 healthy subjects (61.6+/-4.5 years, 5 women/20 men, FEV1: 100+/-14% predicted) during recovery after an exercise test. Heart rate was measured at peak exercise and at 1-min recovery, the difference between the two being defined as HRR (11+/-9 beats in COPD patients vs. 20+/-9 beats in healthy subjects, P < 0.0001). During a mean follow-up of 43.1+/-22.0 months, 32 patients died. Abnormal HRR (14 beats) was a strong predictor of mortality in COPD patients (adjusted hazard ratio: 5.12, 95% CI [1.54-17.00]). In conclusion, COPD patients have a lower HRR than healthy subjects, and have a worse prognosis when presenting abnormal HRR.

Aged↗
PubMed2005

Meta-analysis of silicosis and lung cancer.

OBJECTIVES: This study examined the association between silicosis and lung cancer in a systematic review (and meta-analysis) of the epidemiologic literature, with special reference to the methodological quality of observational studies. METHODS: We searched Medline, Toxline, BIOSIS and Embase (1966-May 2004) for original articles published in any language and systematically reviewed the bibliographies of the retrieved articles. Observational studies (cohort and case-control studies) were selected if they reported a measure of association [standardized mortality ratio (SMR), relative risk or odds ratio] relating lung cancer to silicosis. RESULTS: Thirty-one studies (27 cohort studies, 4 case-control studies) met the inclusion criteria of the meta-analysis. Without any adjustment for smoking, the meta-analysis of the cohort studies indicated that the common SMR was 2.45 [95% confidence interval (95% CI) 1.63-3.66; homogeneity P<0.0001]. When the results of the cohorts for which mortality data were adjusted for smoking were pooled, the common SMR was 1.60 (95% CI 1.33-1.93; homogeneity P=0.52). In a "dose-response" analysis, the profusion of small and large opacities found in chest X-rays correlated with the risk of death from lung cancer. Overall, the case-control studies were more conservative in their conclusions. CONCLUSIONS: Because of biases inherent to observational studies, it is likely that the risk of lung cancer among silicosis patients is overestimated in the current literature. There is nevertheless evidence, from data restricted to never-smokers and from a "dose-response" analysis, that silicosis and lung cancer are associated.

Bias↗
PubMed2004

Pulmonary rehabilitation: an integral part of the long-term management of COPD.

Pulmonary rehabilitation comprises a variety of interventions grouped into three main categories: exercise training, education, and psychological support. Typically, patients participate in a programme of exercise rehabilitation 2-3 times a week for 6-12 weeks, at the same time being encouraged to incorporate breathing and stretching exercises as part of their daily routine. The physiological rationale for pulmonary rehabilitation in COPD is primarily based on its effect on peripheral muscle dysfunction. A recent meta-analysis demonstrated that pulmonary rehabilitation is effective in reducing dyspnoea and fatigue as well as improving patients' sense of control (mastery) over their condition. Without compliance with a maintenance programme these improvements will diminish with time. The value of various components of rehabilitation, programme length, the required degree of supervision, the intensity of training and the best approach to maintaining programme adherence represent issues that remain to be explored.

Breathing Exercises↗
PubMed2004

Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences.

BACKGROUND: Sleeve lobectomy (SL) in a lung-saving procedure indicated for central tumors for which the alternative is pneumonectomy (PN). Although it has been suggested that it may provide as good if not better survival results than pneumonectomy in the treatment of lung cancer, there are very few reports of clinical series comparing operative mortality, survival, and sites of recurrences between these procedures. METHODS: Survival and sites of recurrences were analyzed and compared in 1,230 consecutive patients who underwent PN (n = 1,046) or SL (n = 184) in a single institution. Sleeve lobectomy was always done when technically possible. Thus PN was reserved for lesions that could not be removed by a bronchoplastic procedure. Pathologic staging was accomplished by nodal sampling except for N2 and selected N1 patients who underwent mediastinal lymphadenectomy. Ultimately, all patients were staged according to the 1997 TNM nomenclature. RESULTS: There were 3 operative deaths of the 184 SL patients (operative mortality of 1.6%) and 55 operative deaths of the 1,046 PN patients (operative mortality of 5.3%, p = 0.036). Follow-up was complete for all 1,230 patients. For the entire group, survival at 5 years was 52% after SL and 31% after PN (p < 0.0001). These rates for patients with complete resection were 58% for SL and 33% for PN (p = 0.021). There was also a significant difference in survival favoring SL for patients with pathologic stage I (p = 0.018) and stage II (p = 0.005) disease. When recurrences occurred (n = 577), the site of first recurrence was local in 22% of patients with SL and in 35% of patients with PN. CONCLUSIONS: Sleeve lobectomy can be done with a much lower risk of operative mortality than PN. Although it is recognized that stage for stage, PN patients likely have more advanced disease, long-term survival and local control are significantly better when complete resection can be achieved by SL.

Carcinoma, Non-Small-Cell Lung↗
PubMed2004

Accuracy of virtual bronchoscopy to detect endobronchial lesions.

BACKGROUND: Virtual bronchoscopy (VB) could obviate flexible bronchoscopy (FB) if no endobronchial lesion is detected in patients presenting with a suspicion of malignancy. Our objectives were to evaluate the accuracy (in terms of sensitivity and specificity) of VB in detecting endobronchial lesions, and to determine the anatomical limit of detection of endobronchial lesions by VB. METHODS: This study involved, in a blind comparison of VB and FB, consecutive patients presenting with symptoms or plain chest radiography abnormalities raising the suspicion of pulmonary neoplasm. After the standard chest computed tomography (CT), additional helical CT data were acquired from the aortic arch to the origin of the segmental bronchi of the inferior lobes in one 20-second breath hold using an helicoidal CT scan (3.0-mm collimation with a pitch of 1.5 and 1.5-mm reconstruction intervals). RESULTS: One hundred ninety patients were enrolled; 136 patients (including 63 with an endobronchial lesion at FB) contributed to the primary analysis. The sensitivity and specificity of VB to detect endobronchial lesions were 68% (95% confidence interval [CI]: 55% to 79%) and 90% (95% CI: 81% to 96%), respectively. Overall, the agreement between VB and FB regarding the location on endobronchial lesions was substantial (weighted kappa: 0.66). However, VB detected only 26 of the 34 lobar lesions (sensitivity: 76%; CI: 59% to 89%) and 11 of the 23 segmental lesions (sensitivity: 48%; CI: 27% to 69%). CONCLUSIONS: Beyond the mainstem bronchi, VB is not accurate enough to detect endobronchial lesions and to obviate FB in patients presenting with a suspicion of malignancy.

Bronchial Neoplasms↗
PubMed2004

Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors.

BACKGROUND: Patients with a mediastinal mass are at risk for cardiorespiratory complications in the perioperative period. The authors' objectives were to evaluate the incidence of life-threatening intraoperative cardiorespiratory and postoperative respiratory complications in adult patients and to study the usefulness of clinical signs and symptoms, radiologic evaluation, and pulmonary function tests in the determination of the perioperative risk. METHODS: The authors reviewed the investigation and treatment of adult patients presenting with anterior or middle mediastinal masses for surgery under anesthesia between January 1994 and July 2000. RESULTS: Ninety-eight patients underwent 105 anesthetic cases. The incidences of intraoperative cardiorespiratory and postoperative respiratory complications were 4 in 105 and 11 in 105, respectively. No collapse of the airways occurred during anesthesia. However, a high incidence of early postoperative life-threatening respiratory complications was observed (7 in 105). In a multivariate logistic regression analysis model, perioperative complications were predicted by the occurrence of cardiorespiratory signs and symptoms at the initial presentation (odds ratio [OR], 6.2) and the presence of combined obstructive and restrictive patterns (mixed pulmonary syndrome) on pulmonary function tests (OR, 3.9). Intraoperative complications were associated with pericardial effusion on computed tomography scan (OR, 19.8). Postoperative respiratory complications were related to tracheal compression of more than 50% on preoperative computed tomography scan evaluation (OR, 7.4) and mixed pulmonary syndrome on pulmonary function tests (OR, 15.1). CONCLUSION: Obstruction of the airway in an adult with a mediastinal mass is a rare event in the intraoperative period. Nevertheless, caution should be observed for the occurrence of early postoperative life-threatening respiratory complications. Patient at high risk of perioperative complications can be identified by the occurrence of cardiopulmonary signs and symptoms at presentation, combined obstructive and restrictive pattern on pulmonary function tests, and computed tomography scan findings (tracheal compression > 50%, pericardial effusion, or both).

Adult↗
PubMed2003

Clinical diagnosis of hypersensitivity pneumonitis.

The diagnosis of hypersensitivity pneumonitis (HP) is difficult and often relies on histopathology. Our objective was to identify diagnostic criteria and to develop a clinical prediction rule for this disease. Consecutive patients presenting a condition for which HP was considered in the differential diagnosis underwent a program of simple standardized diagnostic procedures. High-resolution computed tomography scan and bronchoalveolar lavage (BAL) defined the presence or absence of HP. Patients underwent surgical lung biopsy when the computed tomography scan, BAL, and other diagnostic procedures failed to yield a diagnosis. A cohort of 400 patients (116 with HP, 284 control subjects) provided data for the rule derivation. Six significant predictors of HP were identified: (1) exposure to a known offending antigen, (2) positive precipitating antibodies to the offending antigen, (3) recurrent episodes of symptoms, (4) inspiratory crackles on physical examination, (5) symptoms occurring 4 to 8 hours after exposure, (6) and weight loss. The area under the receiver operating characteristic curve was 0.93 (95% confidence interval: 0.90-0.95). The rule retained its accuracy when validated in a separate cohort of 261 patients. The diagnosis of HP can often be made or rejected with confidence, especially in areas of high or low prevalence, respectively, without BAL or biopsy.

Algorithms↗
PubMed2003

Transthoracic needle biopsy in the diagnosis of solitary pulmonary nodules: a survey of Canadian physicians.

OBJECTIVE: To describe Canadian physicians' opinions relative to the choice of diagnostic procedures in patients presenting with a solitary pulmonary nodule and to identify the attributes that may influence their decision. METHODS: We conducted a mailed survey among Canadian physicians including pulmonologists, thoracic surgeons, radiologists, and internists. Five hypothetical clinical scenarios designed to illustrate a wide spectrum of clinical situations (including nodules associated to very low, indeterminate, and high probabilities of malignancy in patients medically fit or unfit to undergo surgical resection) were submitted to each physician who had to choose among options of diagnostic procedures and to estimate the pretest probability of malignancy. RESULTS: The survey response rate was 47%. Overall, the physicians tended to overestimate the probability of malignancy. Twenty-eight percent of the respondents would have ordered a transthoracic needle biopsy in a medically fit patient presenting with a very low probability (< 2%) of malignancy, whereas 53% would have done so in a medically fit patient presenting with a very high probability (75%) of malignancy. In a regression analysis, the significant predictors of the use of transthoracic needle biopsy were (1) the pretest probability of cancer, (2) the patient's operability, (3) specialty (pulmonologists and thoracic surgeons being less likely to order a transthoracic needle biopsy than radiologists), and (4) the respondent's gender. CONCLUSIONS: There are widespread variations in clinical opinions among Canadian physicians regarding the use of transthoracic needle biopsy in the investigation of solitary nodules. Hypothetical transthoracic needle biopsy was often preferred when the result was unlikely to affect patient management.

Biopsy, Needle↗
PubMed2003

A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD.

STUDY OBJECTIVES: The potential benefits of noninvasive positive pressure ventilation (NIPPV) for patients with COPD remains inconclusive, as most studies have included only a small number of patients. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) that compared nocturnal NIPPV with conventional management in patients with COPD and stable respiratory failure. DESIGN: RCTs were identified from several sources, such as MEDLINE, EMBASE, and CINAHL. In addition, records were identified through hand searching of abstracts from meetings of the American Thoracic Society, the American College of Chest Physicians, and the European Respiratory Society. PATIENTS: Patients with COPD according to the definition of the American Thoracic Society. INTERVENTIONS: NIPPV applied via a nasal or facemask for at least 5 h/d for at least 3 weeks. Patients in the actively treated group continued to receive the usual management for COPD. The control group received the same management as the study group but did not receive NIPPV. MEASUREMENTS AND RESULTS: PaCO(2), PaO(2), 6-min walking distance (6MWD), respiratory muscle function, FEV(1), vital capacity, and sleep efficiency (time asleep as a percentage of total time in bed) were used as outcome measures. The publications were reduced to 10 potentially eligible articles from 164 publications retrieved from computer searches and 8 further abstracts. Four trials were finally included in the meta-analysis. The only outcome for which the confidence intervals excluded zero was maximal inspiratory pressure (PImax). The confidence intervals for the other outcomes included zero. The mean treatment effects for FEV(1) and PImax were small, whereas it was moderate for the 6MWD. Small negative effects were found for the outcomes of vital capacity, PaCO(2), and sleep efficiency. CONCLUSIONS: This meta-analysis of 3 months of NIPPV in patients with stable COPD showed that ventilatory support did not improve lung function, gas exchange, or sleep efficiency. The high upper limit of the confidence interval for the 6MWD suggested that some people do improve their walking distance. The small overall sample size precluded a clear clinical direction regarding the effects of NIPPV in patients with COPD.

Humans↗
PubMed2002

Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease.

This study was undertaken to test the hypothesis that a reduction in midthigh muscle cross-sectional area obtained by CT scan (MTCSA(CT)) is a better predictor of mortality in chronic obstructive pulmonary disease (COPD) than low body mass index (BMI). We also wished to evaluate whether anthropometric measurements could be used to estimate MTCSA(CT). One hundred forty-two patients with COPD (age = 65 +/- 9 years, mean +/- SD, 26 F, BMI = 26 +/- 6 kg/m(2), FEV(1) = 42 +/- 16% predicted) were recruited from September 1995 to April 2000 with a mean follow-up of 41 +/- 18 months. The primary end-point was all-cause mortality during the study period. A Cox proportional hazards regression model was used to predict mortality using the following independent variables: age, sex, daily use of corticosteroid, FEV(1), DL(CO), BMI, thigh circumference, MTCSA(CT), peak exercise workrate, Pa(O2), and Pa(CO2). Only MTCSA(CT) and FEV(1) were found to be significant predictors of mortality (p = 0.0008 and p = 0.01, respectively). A second analysis was also performed with FEV(1) and MTCSA(CT) dichotomized. Patients were divided into four subgroups based on FEV(1) (< or >or= 50% predicted) and MTCSA(CT) (< or >or= 70 cm(2)). Compared with patients with an FEV(1) >or= 50% predicted and a MTCSA(CT) >or= 70 cm(2), those with an FEV(1) < 50% predicted and a MTCSA(CT) >or= 70 cm(2) had a mortality odds ratio of 3.37 (95% confidence interval, 0.41-28.00), whereas patients with an FEV(1) < 50% predicted and a MTCSA(CT) < 70 cm(2) had a mortality odds ratio of 13.16 (95% confidence interval, 1.74-99.20). MTCSA(CT) could not be estimated with sufficient accuracy from anthropometric measurements. In summary, we found in this cohort of patients with COPD that (1) MTCSA(CT) was a better predictor of mortality than BMI, and (2) MTCSA had a strong impact on mortality in patients with an FEV(1) < 50% predicted. These findings suggest that the assessment of body composition may be useful in the clinical evaluation of these patients.

Aged↗
PubMedDate not supplied

Smoking cessation in pulmonary rehabilitation: goal or prerequisite?

It has been more than 35 years since the Surgeon General of the United States released the first report of the Advisory Committee on Smoking and Health. Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality in North America. During the 1990s, tobacco was the largest single cause of premature death in the developed world. Smoking cessation is followed by immediate health benefits in terms of symptoms and organ function. It dramatically reduces the risk of most smoking-related diseases, including chronic obstructive pulmonary disease and lung cancer. Respiratory rehabilitation has been defined as a multidimensional continuum of services directed to persons with pulmonary disease and their families, usually by an interdisciplinary team of specialists, with the goal of achieving and maintaining the individual's maximum level of independence and functioning in the community. A European Respiratory Society task force on rehabilitation recently commented that respiratory rehabilitation must address medical management including reinforcement of smoking cessation, education of the patient and family, exercise reconditioning, physical and occupational therapy, nutritional support, and long-term oxygen therapy. Many patients have quit smoking by the time they enroll in a pulmonary rehabilitation program. Nevertheless, the inclusion of smokers in respiratory rehabilitation programs remains controversial. Among 14 trials included in a meta-analysis of respiratory rehabilitation of patients with chronic obstructive pulmonary disease (COPD), the smoking status of the patients was reported in 9 of the trials, and only 2 trials stated that smoking was an absolute exclusion criterion for enrollment. Some investigators have used a trial of smoking cessation as an index of the patient's motivation to improve his or her health status. This article describes the effect of smoking on the course of COPD and the opportunity to address smoking in the context of comprehensive rehabilitation. The authors' line of reasoning is that (1) smoking causes COPD and perpetuates the pathophysiologic processes defining the disease, (2) symptomatic COPD does not facilitate smoking cessation, (3) smoking may alter rehabilitation outcomes, and (4) if smoking cessation is not a prerequisite to pulmonary rehabilitation, then a smoking cessation intervention should at least he offered as part of such a program.

Humans↗
PubMedDate not supplied

State of the Art Compendium: Canadian Thoracic Society recommendations for the management of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society's evidence-based guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. The main message of the guidelines is that COPD is a preventable and treatable disease. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and former smokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated on an individual basis in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta-2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care. Management strategies, consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation and exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD.

Canada↗