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Old 02-26-2012
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Lungs Treatment of COPD

hi all:

In kaplan CK LN, it says that the treatment of COPD: first: anticholinergic agents and then Beta2 agnists

But in MTB CK, it says that the first step is Beta2 agonists and then anticholinergics.

Can someone please tell me what is the correct answer?

Thank you!
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Old 02-26-2012
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The absolute correct answer is that they should both be used. This is in accordance with the most recent GOLD guidelines on management of COPD.

If you had to choose one first, then MTBCK is correct: B2 agonists, then add anticholinergics. This is in accordance with the older guidelines.

Using anticholinergics first was published in an Annals of Internal Medicine analysis from 2001 and picked up by the NEJM article that is still used as the reference for Pocket Medicine, and it was based on some preliminary reports of long-term adverse effects of B2 agonists; however, further research did not back that up, so the recommendation was switched to B2 agonists first (mostly based on price and availability, I think), then to both together after it was shown that the combination of bronchodilators had greater efficacy than either alone.
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Old 02-26-2012
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Yes MTB sais B2 agonist first then followed by anticholinergic
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Internal-Medicine-, Pulmonology-

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