Brand P, Hederer B, Austen G, et al. Higher lung deposition with Respimat Soft Mist inhaler than HFA-MDI in COPD patients with poor technique. Int J Chron Obstruct Pulmon Dis.2008;3:763–770.
British Thoracic Society Standards of Care Committee. BTS statement on criteria for specialist referral, admission, discharge and follow-up for adults with respiratory disease. Thorax. 2008;63 Suppl 1:i1-i16.
Calverley PMA, Tetzlaff K, Vogelmeier C, et al. Eosinophilia, frequent exacerbations, and steroid response in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;196:1219-1221.
Chapman KR, Hurst JR, Frent SM, et al. Long-term triple therapy de-escalation to indacaterol/glycopyrronium in patients with chronic obstructive pulmonary disease (SUNSET): a randomized, double-blind, triple-dummy clinical trial. Am J Respir Crit Care Med. 2018;198:329-339.
COPD-X Guidelines - Version 2.56. https://copdx.org.au/copd-x-plan/confirm-diagnosis/c5-specialist-referral. Published December 2018. Accessed June 7, 2019.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2019 report. https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf. Accessed July 12, 2019.
Kaplan A, Roman- Rodriguez M, Price DB, et al. IPCRG Desktop Helper No. 6: Evaluation of appropriateness of inhaled corticosteroid (ICS) therapy in COPD and guidance on ICS withdrawal. 2017. Corrected 2018. https://www.theipcrg.org/display/TreatP/Desktop+helper+6%3A+Evaluation+of+appropriateness+of+inhaled+corticosteroid+%28ICS%29+therapy+in+COPD+and+guidance+on+ICS+withdrawal?preview=/35390454/53968925/ICS%20desktop%20helper_FINAL%20WEB%20v.2%20(1).pdf. Accessed July 12, 2019.
Kerkhof M, Freeman D, Jones R, et al; Respiratory Effectiveness Group. Predicting frequent COPD exacerbations using primary care data. Int J Chron Obstruct Pulmon Dis. 2015;10:2439-2450.
Lipson DA, Barnhart F, Brealey N, et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med; 2018;378:1671-1680.
Loh CH, Peters SP, Lovings TM, et al. Suboptimal inspiratory flow rates are associated with chronic obstructive pulmonary disease and all-cause readmissions. Ann Am Thorac Soc. 2017;14:1305-1311.
Magnussen H, Disse B, Rodriguez-Roisin R, et al. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med. 2014;371:1285-1294.
Magnussen H, Watz H, Kirsten A. Stepwise withdrawal of inhaled corticosteroids in COPD patients receiving dual bronchodilation: WISDOM study design and rationale. Respir Med. 2014;108:593-599.
Newman SP, Brown J, Steed KP, et al. Lung deposition of fenoterol and flunisolide delivered using a novel device for inhaled medicines: comparison of RESPIMAT with conventional metered-dose inhalers with and without spacer devices. Chest. 1998;113:957-963.
Papi A, Vestbo J, Fabbri L, et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet. 2018;391:1076-1084.
Price D, Yawn B, Brusselle G, et al. Risk-to-benefit ratio of inhaled corticosteroids in patients with COPD. Prim Care Respir J. 2013;22:92-100.
Price D, West D, Brusselle G, et al. Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns. Int J Chron Obstruct Pulmon Dis. 2014;9:889-905.
Price DB, Román-Rodríguez M, McQueen RB, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract. 2017;5:1071-1081.e9.
Price DB, Yang S, Ming SWY, et al. Physiological predictors Of peak inspiRatory flow using Observed lung function resultS (POROS): evaluation at discharge among patients hospitalized for a COPD exacerbation. Int J Chron Obstruct Pulmon Dis. 2018;13:3937-3946.
Qureshi H, Sharafkhaneh A, Hanania NA. Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. Ther Adv Chronic Dis. 2014;5:212-227.
Soriano JB, Zielinski J, Price D. Screening for and early detection of chronic obstructive pulmonary disease. Lancet 2009;374:721-732.
Sulaiman I, Cushen B, Greene G, et al. Objective assessment of adherence to inhalers by patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;195:1333-1343.
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Voorham J, Price D.B, Brusselle G, et al. Osteoporosis onset in patients prescribed ICS for COPD: matched cohort study. Presented at: ERS International Congress 2018. September 15-19; Paris, France. Poster PA3621.
Wedzicha JA, Banerji D, Chapman KR, et al. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. N Engl J Med. 2016;374:2222-2234.
Westerik JA, Carter V, Chrystyn H, et al. Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting. J Asthma. 2016;53:321-329.
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WebMD Global requires each individual who is in a position to control the content of one of its educational activities to disclose any relevant financial relationships occurring within the past 12 months that could create a conflict of interest.

Faculty

David B. Price, FRCGP

Professor, Primary Care Respiratory Medicine, University of Aberdeen
Director, Observational & Pragmatic Research Institute, Singapore
Director, Optimum Patient Care, Australia and United Kingdom

Disclosures

Disclosure: David B. Price, FRCGP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Chiesi Pharmaceuticals, Inc. ; GlaxoSmithKline; Mundipharma; Mylan Laboratories Inc.; Napp Pharmaceuticals Limited; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Teva Pharmaceuticals USA; Theravance, Inc.
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Chiesi Pharmaceuticals, Inc.; Cipla Ltd.; GlaxoSmithKline; Kyorin Pharmaceutical Co., Ltd.; Merck & Co., Inc.; Mundipharma; Mylan Laboratories Inc. Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi Genzyme Corporation; Teva Pharmaceuticals USA
Received grants for clinical research from: AKL Research and Development Ltd.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Chiesi Pharmaceuticals, Inc.; Circassia, Ltd.; Mundipharma; Mylan Laboratories Inc.; Napp Pharmaceuticals Limited; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi Genzyme Corporation; Teva Pharmaceuticals USA; Theravance, Inc.; Zentiva Group, a.s.
Owns stock, stock options, or bonds from: AKL Research and Development Ltd.; OPRI; Optimum Patient Care
Other: Board membership: Amgen Inc.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Chiesi Pharmaceuticals, Inc.; Circassia, Ltd.; Mundipharma; Mylan Laboratories Inc.; Napp Pharmaceuticals Limited; Novartis Pharmaceuticals Corporation; Regeneron Pharmaceuticals, Inc.; Sanofi Genzyme Corporation; Teva Pharmaceuticals USA; Manuscript preparation: Mundipharma; Teva Pharmaceuticals USA

Editors

Wilma M. Guerra, BA, ELS

Medical Education Director, WebMD Global, LLC

Disclosures

Disclosure: Wilma M. Guerra, BA, ELS, has disclosed no relevant financial relationships.

Renata Feldman, PharmD, RPh

Scientific Content Manager, Medscape, LLC

Disclosures

Disclosure: Renata Feldman, PharmD, RPh has disclosed no relevant financial relationships.

Content Reviewer

Hazel Dennison, DNP, RN, FNP, CPHQ, CNE

Associate Director, Accreditation and Compliance, Medscape, LLC

Disclosures

Disclosure: Hazel Dennison, DNP, RN, FNP, CPHQ, CNE, has disclosed no relevant financial relationships.

CPD

Diagnosis, Assessment, and Treatment of the COPD Patient in Primary Care

Authors: David B. Price, FRCGP
CPD Released: 8/14/2019
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 8/14/2020

Start Activity

Target Audience and Goal Statement

This educational activity is intended for an international audience of non-US primary care physicians, pulmonologists, and allergists and clinical immunologists.

The goal of this activity is to educate clinicians on Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD); diagnosis, assessment, and treatment of COPD based on patient presentation; and selection of appropriate treatment for bronchodilation for optimal patient outcomes.

Upon completion of this activity, participants will:

Have increased knowledge regarding the
- Basis of revised GOLD guidelines for the treatment of COPD
- Therapeutic recommendations for individual patient profiles based on severity of symptoms, exacerbation history, relevant biomarkers, and risk
Have greater competence related to
- The appropriate and practical use of dual long-acting beta-agonist (LABA)/long-acting muscarinic-antagonist (LAMA) bronchodilation
- The diagnosis and evaluation of the breathless patient for COPD in primary care
Demonstrate greater confidence in their ability to
- Withdraw unneeded inhaled corticosteroid (ICS) therapy, and for which phenotypes it may be appropriate

Disclosures

Faculty

David B. Price, FRCGP

Professor, Primary Care Respiratory Medicine, University of Aberdeen
Director, Observational & Pragmatic Research Institute, Singapore
Director, Optimum Patient Care, Australia and United Kingdom

Disclosures

Disclosure: David B. Price, FRCGP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Chiesi Pharmaceuticals, Inc. ; GlaxoSmithKline; Mundipharma; Mylan Laboratories Inc.; Napp Pharmaceuticals Limited; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Teva Pharmaceuticals USA; Theravance, Inc.
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Chiesi Pharmaceuticals, Inc.; Cipla Ltd.; GlaxoSmithKline; Kyorin Pharmaceutical Co., Ltd.; Merck & Co., Inc.; Mundipharma; Mylan Laboratories Inc. Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi Genzyme Corporation; Teva Pharmaceuticals USA
Received grants for clinical research from: AKL Research and Development Ltd.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Chiesi Pharmaceuticals, Inc.; Circassia, Ltd.; Mundipharma; Mylan Laboratories Inc.; Napp Pharmaceuticals Limited; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi Genzyme Corporation; Teva Pharmaceuticals USA; Theravance, Inc.; Zentiva Group, a.s.
Owns stock, stock options, or bonds from: AKL Research and Development Ltd.; OPRI; Optimum Patient Care
Other: Board membership: Amgen Inc.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Chiesi Pharmaceuticals, Inc.; Circassia, Ltd.; Mundipharma; Mylan Laboratories Inc.; Napp Pharmaceuticals Limited; Novartis Pharmaceuticals Corporation; Regeneron Pharmaceuticals, Inc.; Sanofi Genzyme Corporation; Teva Pharmaceuticals USA; Manuscript preparation: Mundipharma; Teva Pharmaceuticals USA

Editors

Wilma M. Guerra, BA, ELS

Medical Education Director, WebMD Global, LLC

Disclosures

Disclosure: Wilma M. Guerra, BA, ELS, has disclosed no relevant financial relationships.

Renata Feldman, PharmD, RPh

Scientific Content Manager, Medscape, LLC

Disclosures

Disclosure: Renata Feldman, PharmD, RPh has disclosed no relevant financial relationships.

Content Reviewer

Hazel Dennison, DNP, RN, FNP, CPHQ, CNE

Associate Director, Accreditation and Compliance, Medscape, LLC

Disclosures

Disclosure: Hazel Dennison, DNP, RN, FNP, CPHQ, CNE, has disclosed no relevant financial relationships.

Accreditation Statements

For Physicians

The Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the United Kingdom (FPM) has reviewed and approved the content of this educational activity and allocated it 0.5 continuing professional development credits (CPD).

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From Medscape Education

CPD

Diagnosis, Assessment, and Treatment of the COPD Patient in Primary Care

Authors: David B. Price, FRCGPFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CPD Released: 8/14/2019

Valid for credit through: 8/14/2020

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Educational Impact Challenge

Before you begin this activity, please assess your clinical knowledge by completing this brief survey. Answering these questions again after the activity will allow you to see what you learned and to compare your answers with those of your peers.

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Disclaimer

The educational activity presented above may involve simulated, case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient, whether living or deceased, is intended or should be inferred. The material presented here does not necessarily reflect the views of Medscape, LLC, or any individuals or commercial entities that support companies that support educational programming on medscape.org. These materials may include discussion of therapeutic products that have not been authorized by the European Medicines Agency for use in Europe, off-label uses of authorized products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer-reviewed journal. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.

References

Faculty and Disclosures

Faculty

David B. Price, FRCGP

Editors

Wilma M. Guerra, BA, ELS

Renata Feldman, PharmD, RPh

Content Reviewer

Hazel Dennison, DNP, RN, FNP, CPHQ, CNE

CPD

Diagnosis, Assessment, and Treatment of the COPD Patient in Primary Care

Target Audience and Goal Statement

Disclosures

Faculty

David B. Price, FRCGP

Editors

Wilma M. Guerra, BA, ELS

Renata Feldman, PharmD, RPh

Content Reviewer

Hazel Dennison, DNP, RN, FNP, CPHQ, CNE

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Diagnosis, Assessment, and Treatment of the COPD Patient in Primary Care

Educational Impact Challenge