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Dual Bronchodilator in COPD Dr Ma3hew Wong Respiratory Medicine Hon Clinical Assistant Professor (HKU) COPD “COPD, a common preventable and treatable disease, is characterized by persistent airflow limita<on that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious par<cles or gases. Exacerba<ons and comorbidi<es contribute to the overall severity in individual pa<ents. 2 of COPD, GOLD 2014 Global Strategy for the Diagnosis, Management and PrevenJon Pathophysiology of COPD Alveolar wall destrucJon  Enphysema Mucus hypersecreJon + Epithelial cell damage  Small airway disease (Bronchi5s) 3 Epidemiology of COPD in Hong Kong • 4.6% -­‐ self reported COPD in populaJon aged 65 years or above in Hong Kong, the pooled esJmate of prevalence around the world is 14.2% • 12.4 – 25.9% -­‐ based on spirometry test among those aged 60 and above • COPD is common in Hong Kong parJcularly in paJents over 60 Trend of Disease Burden Consequent to Chronic Lung Disease in Older Persons in Hong Kong: 4 2011 ImplicaJons of PopulaJon Ageing, The Hong Kong Jockey Club, Typical COPD paJent 5 ICS – side effects • While ICS have a smaller therapeuJc role in COPD than in asthma, paJents are more at risk from side effects. 25 Price D, et al., Prim Care Respir J 2013, 22(1): 92 Breezhaler inhaler device Low Resistance Feedback Mechanism PaJent Preference 26 Breezhaler inhaler device • Whirring noise on inhalaJon • Lactose taste on inhalaJon • Transparent capsules Sweet 27 Breezhaler inhaler device • Low resistance DPIs tend to be more accepted by paJents than high resistance DPIs • Onbrez Breezhaler has low resistance than other inhalers Breezhaler Diskus Turbuhaler HandiHaler 28 Singh D, et al., Poster presented at the American Thoracic Society Conference, LA, May 2010