Incorporating new evidence on inhaled medications in COPD. The latin American chest association (ALAT) 2019

• Published in: Archivos de bronconeumología (English ed.) 2020-02, Vol.56 (2), p.106-113
• Main Authors: Montes de Oca, Maria, Varela, Maria Victorina López, Acuña, Agustín, Schiavi, Eduardo, Casas, Alejandro, Tokumoto, Antonio, Duque, Carlos A. Torres, Ramírez-Venegas, Alejandra, García, Gabriel, Camelier, Aquiles, Bergna, Miguel, Cohen, Mark, Sanchez-Angarita, Efraín, Guzmán, Santiago, Czischke, Karen, Barros, Manuel, Rey, Alejandra
• Format: Article
• Language: English
• Subjects: Chronic obstructive pulmonary disease; COPD; Enfermedad pulmonar obstructiva crónica; EPOC; Inhaled medication; Medicación inhalada
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/j.arbr.2019.09.002

This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting β2-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of < 300 cells/μl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD. Este documento sobre EPOC de la Asociación Latinoamericana de Tórax (ALAT)-2019 analiza las nuevas evidencias de medicación inhalada utilizando la metodología de preguntas clínicas en formato PICO. Surgen de este análisis los siguientes puntos claves: 1) No hay evidencia que compare el uso de broncodilatadores de acción corta vs. larga en pacientes con EPOC leve; en aquellos con EPOC moderada-grave existe mayor beneficio de los broncodilatadores de acción larga, 2) beneficios similares de la monoterapia con antimuscarínicos de acción prolongada (LAMA) y la terapia combinada β2-agonistas de acción larga/corticosteroides inhalados (LABA/CIS), asociada esta última a mayor riesgo de neumonía 3) mayores beneficios del LABA/LAMA en función pulmonar y riesgo de exacerbación vs. LABA/CIS (esta última con mayor riesgo de neumonía), 4) mayores beneficios de la terapia LAMA/LABA/CIS comparada con LABA/LAMA sobre el riesgo de exacerbaciones moderadas-severas. En relación al rol de los eosinófilos para guiar el uso de CIS: debe consider