UPDATED guidelines for the management of chronic obstructive pulmonary disease (COPD) include non-pharmacological and pharmacological strategies to reflect the importance of a holistic approach to clinical care for people living with the disease.
Developed by the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand, and published as a summary in the MJA, the guidelines include 26 recommendations that address:
- case detection and diagnosis confirmation: confirmation by spirometry, blood eosinophil levels, behavior and risk factors (smoking, adherence to treatment, self-management skills, physical activity, comorbid conditions);
- optimization of function: non-pharmacological therapies, drug therapies, management of comorbid conditions, palliative care, lung volume reduction surgery, pulmonary rehabilitation, non-invasive ventilation;
- prevent deterioration: smoking cessation, immunization, oxygen therapy, prophylactic antibiotics, biological therapies, palliative care, home bilevel ventilation;
- develop a plan of care; i
- management of exacerbations: pharmacological management, non-invasive ventilation and multidisciplinary care.
“It is estimated that approximately one in 13 Australians over the age of 40 has chronic obstructive pulmonary disease (COPD),” wrote the authors, led by Associate Professor Eli Dabscheck, a respiratory and sleep physician at the Alfred Hospital in Melbourne.
“In 2018, COPD was the leading cause of potentially avoidable hospital admissions, the third specific cause of total disease burden and the fifth leading cause of death in Australia. The impact of COPD is even greater among Australians Indigenous compared to non-Indigenous Australians”.
Nonpharmacologic therapies for COPD include walking and structured exercise, as well as pulmonary rehabilitation to improve dyspnea, exercise performance, physical activity level, and health status. Pharmacologic therapies, including short- and long-acting inhaled bronchodilators, inhaled corticosteroids (ICS), and long-acting β-agonists, are evaluated in the guidelines.
Full guidelines are available at
Supervised injection centers: 21 years of evidence
Twenty-one years after Uniting Sydney’s Medically Supervised Injection Center (MSIC) was established, research shows that rather than becoming a ‘honeypot’, the MSIC has given rise to a improved and sustained public facilities, which has led to a call for the establishment of more supervised injection facilities. Associate Professor Carolyn Day, from the University of Sydney, and her colleagues wrote in the MJA that they had “addressed key questions about [supervised injecting facility (SIF)] operations and state that there is sufficient evidence to support the deployment and expansion of SIF.” “Good policy, with clear legislation and careful client management within a harm reduction framework, can alleviate problems that may be perceived as inherent in the operation of these services. Given the strong evidence, current governments, in Australia and elsewhere, should expand SIF services without unnecessary prolonged trial periods. The key challenge in the ‘expansion of SIF is to support legislation. Questions about the scientific and operational merit of SIFs have been answered. After 21 years of success, it is time for strong support to implement additional services both in Australia and internationally”.
Neurological manifestations of COVID-19 in adults and children
An international group of researchers, including from Australia, has detailed the differences in the neurological manifestations of COVID-19 in adults and children in an article published in Brain. Researchers analyzed data from the International Severe Acute Respiratory and Emerging Infection Consortium cohort at 1,507 sites worldwide from January 30, 2020, to May 25, 2021: 161,239 patients (158,267 adults, 2,972 children) admitted to the hospital with COVID-19 and neurological manifestations. and complications were included. “In adults and children, the most frequent neurological manifestations on admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%). ; 1.9%), anosmia (6.0%; 2.2%) and seizures (1.1%; 5.2%). In adults, the most common in-hospital neurologic complications were stroke (1.5%), seizures (1%), and central nervous system (CNS) infection (0.2%). Each occurred most frequently a [intensive care unit (ICU)] than in non-ICU patients. In children, seizures were the only neurological complication that occurred more frequently in ICU versus non-ICU (7.1% vs. 2.3%, p < 0.001). The prevalence of stroke increased with age, while infection and CNS seizures decreased steadily with age. There was a dramatic decline in stroke over time during the pandemic. Hypertension, chronic neurologic disease, and the use of extracorporeal membrane oxygenation were associated with an increased risk of stroke. Impaired consciousness was associated with CNS infection, seizure, and stroke. All in-hospital neurologic complications were associated with increased odds of death. The probability of death increases with age, especially after age 25."
Counting steps is important, but so is a faster cadence
Research published in JAMA Internal Medicine, which includes authors from the University of Sydney, has found that accumulating more steps per day (up to about 10,000) may be associated with a lower risk of all causes, cancer and cardiovascular disease (CVD). . mortality and with a lower incidence of cancer and CVD, and this higher step intensity may provide additional benefits. The authors analyzed data from 78,500 UK Biobank participants for the period 2013–2015, including adults aged 40–79 years. Participants were invited by email to participate in an accelerometer study. Registry-based morbidity and mortality were determined through October 2021. “The study population … was followed for an average of 7 years during which 1325 participants died of cancer and 664 of CVD (total deaths 2179). During the observation period, there were 10 245 CVD events and 2 813 cancer events. More daily steps were associated with a lower risk of all causes ([mean rate of change (MRC)], −0.08; 95% CI, -0.11 to -0.06), CVD (MRC, -0.10; 95% CI, -0.15 to -0.06), and cancer mortality (MRC, 95 CI %, -0.11; -0.15 to -0.06) up to about 10,000 steps. Similarly, accumulating more daily steps was associated with fewer incident illnesses. Maximum cadence of 30 was consistently associated with lower risks across all outcomes, beyond the benefit of total daily steps,” the authors reported. “Steps taken at a higher cadence may be associated with an additional reduction in risk, especially for incident disease.”
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