Changes/additions to materials (reviewed 20/07/10):

Since these materials were published NICE has published a new clinical guideline on the management of COPD in adults in primary and secondary care (CG101). This guideline partly updates and replaces the previous guidance (CG12).

The materials on this floor of NPCi will be updated in 2011, taking the new NICE guidance into account.

CFC-containing inhalers

The last remaining stocks of CFC-containing pharmaceutical metered dose inhalers are now rapidly depleting. Any patients who are still prescribed these products will need to be switched to a suitable alternative as quickly as possible. Please see Blog No.1380 for more information, including links to useful resources to help manage the changeover.

Possible safety concerns with inhaled anticholinergics
The November 2008 edition of Drug Safety Update highlighted new data on the risk of death or stroke with inhaled anticholinergics. As we reported in blogs No. 205 and No. 223, there is some evidence to suggest that inhaled anticholinergic drugs (ipratropium, tiotropium) increase the risk of cardiovascular events in people with chronic obstructive pulmonary disease (COPD) compared with placebo or active comparators (inhaled corticosteroids and/or beta-agonists). However, no such increased risk was demonstrated in the UPLIFT study. As we state in blog No. 235, because of the uncertainty,it is difficult to draw firm conclusions on the risk associated with inhaled anticholinergics. Drug Safety Update concludes that further analyses are needed to shed light on any increased risk, and recommends that patients who take tiotropium for COPD should not exceed the recommended dose.

A MeReC Bulletin on COPD is now available
The Bulletin reviews a number of safety concerns which have emerged relating to inhaled treatments for COPD, and sets them into the context of the potential benefits these treatments have. For example:

• The benefits of long-acting bronchodilators and inhaled corticosteroids for patients with COPD
• The safety issues with long-acting beta2 agonists (LABAs) in COPD
• The safety issues with anticholinergics in COPD
• The safety issues with inhaled corticosteroids in COPD
• What needs to be considered when treatment choices are made.

Test your knowledge (or just have some fun) by answering the questions in this quiz. Suggested answers are given after each question with some additional information and references. You even get a score at the end that you can print out and put in your CPD folder!

To reveal the answer to the quiz questions click on the arrow button at the bottom. The answer will then appear, however, you may need to use the slider on the right hand side of the page to reveal the whole text.