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  1. Timothy Cheung

    Overall a very well written article and I especially like the way you highlight the areas where pharmacists can make a difference. I have just a few comments:

    1) Pharmacists may also have a role in helping patients with so-called “end stage” COPD. These patients will be severely dyspnoeic and on low dose opioids or benzodiazepines for anxiety as well as central suppression of ventilatory drive. Reassurance and encouraging use of these agents when necessary might reduce hospital admissions. There is also the opportunity to manage adverse effects such as constipation.

    2) When you say that COPD treatment will only require inhaled corticosteroids during exacerbations, I think you probably mean that ICS inhalers are most suitable for patient’s with a pattern of frequent exacerbations (especially those already on LAMA/LABAs) as they help to prevent further exacerbations. Many patients on the severe end of the COPD spectrum will require a maintenance ICS inhaler.

    • Jarrod McMaugh

      ICS is only indicated for inflammation.

      Uncomplicated cases (by definition ) don’t have inflammation, therefore ICS is not appropriate.

      Complex cases will have exacerbations wherein inflammation may occur. In these cases, balancing the treatment of inflammation against the risk of pneumonia is critical to prevent morbidity.

      There are cases of COPD and asthma coexisting. For these patients, ICS is still indicated.

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