Riley CM, et al. JAMA. 2019 Feb 26;321(8):786-797.
Question: Aimed to review and provide practical information regarding the diagnosis and long-term management of patients with COPD in the outpatient setting.
Methods: This was a systematic assessment where authors searched multiple sources and simply reviewed articles.
Findings: They suggested the treatment of COPD should be done on a step-wise approach. SAMA and SABA should be used with limited symptoms or activity specific dyspnea. Escalation LAMA and LABA therapy if the use of SAMA and SABA exceeds three times a week. Addition of inhaled steroids in those with an elevated peripheral eosinophil count. Consider adding roflumilast in those patients who are failing triple therapy.
Limitations: This was simply a systematic assessment and not a systematic review or meta-analysis. The authors did not assess the quality of the evidence and risk of bias in the studies they presented.
Interpretation: A good review that showed that the use of long-acting maintenance bronchodilators, inhaled steroids optimized functional performance and reduced exacerbation frequency. However, the conclusions of the study need to be taken with caution as that the authors did not perform a systematic review.
By: Dr. Darren Wong