International Journal of COPD (May 2021)
Towards Rational Prescription of Common Inhaler Medication in the Multimorbid COPD Patient
Abstract
Ioanna Tsiligianni,1 Kristian Jong Hoeines,2 Christian Jensen,3 Janwillem WH Kocks,4– 6 Björn Ställberg,7 Claudia Vicente,8 Rudi Peché9 1Department of Social Medicine, University of Crete, Heraklion, Greece; 2Tananger Legesenter DA, Sola, Norway; 3Lægehuset Remisen, Præstø, Denmark; 4General Practitioners Research Institute, Groningen, the Netherlands; 5University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands; 6Observational and Pragmatic Research Institute, Singapore; 7Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden; 8Unidade Saúde Familiar Araceti, Arazede, Portugal; 9Department of Pneumology, ISPPC, CHU Charleroi, Charleroi, BelgiumCorrespondence: Ioanna TsiligianniDepartment of Social Medicine, University of Crete, Voutes Campus, Heraklion, Crete, 71003, GreeceTel +30 2810394607Email [email protected]: COPD is a chronic disease, typically accompanied by multiple comorbid conditions. The need to apply several, and sometimes conflicting, disease-specific treatment guidelines, complicates the management of individual patients. Moreover, national and international recommendations evolve rapidly but provide limited guidance on the integrated approach in the multimorbid patient. Particularly bothersome is the fact that the presence of comorbidities may deteriorate the course of COPD, and inversely COPD may affect the outcome of the comorbid diseases. In addition, some effects of commonly prescribed COPD inhaler medications, including beta2-agonists, long-acting antimuscarinics and especially inhaled corticosteroids, mimic or worsen COPD-related comorbidities. Therefore, the authors combined their perspectives to formulate advice that may help physicians to improve COPD patient care in daily practice when comorbidities are present. Diabetes, atrial fibrillation, osteoporosis/fractures, infections (pneumonia and tuberculosis) and asthma were identified as areas where practicing clinicians should give special attention to the risk-benefit ratio of the inhaled medication. Overall, the presence of multimorbidity in a COPD patient should act as a signal to carefully reconsider the treatment choices.Keywords: comorbidity, multimorbidity, polypharmacy, inhaler medication
