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Clinical Guidelines Highlights

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AMDA recommends that most LTC residents with COPD should be treated with long-acting maintenance bronchodilators1*

AMDA Recommendation Table

Used by permission. Further reproduction and/or distribution not permitted without written permission from AMDA. Sunovion has derived this information, with permission from AMDA, from the AMDA Clinical Practice Guideline (CPG) on COPD. Sunovion had no involvement in the preparation of the CPG.


Bronchodilators, especially the long-acting forms, are underutilized in PA/LTC.§ —AMDA, 2016



*AMDA–The Society for Post-Acute Care and Long-Term Medicine does not endorse any specific treatments.
Quality of evidence ratings defined as High=at least 1 randomized controlled trial OR 3 pre/post interventions or other prospective interventions or 3 well-structured, relevant observational studies; Moderate=studies that use well-tested methods to make comparisons in a fair way, but where the results leave room for uncertainty (eg, because of the size of the study, losses to follow-up, or the method used for selecting groups for comparison); Low=studies in which the results are doubtful because the study design does not guarantee that fair comparisons can be made.
Strength of recommendation defined as Strong=benefits clearly outweigh risks; Weak=benefits are balanced with risks; Insufficient=evidence is inadequate to make a recommendation.
§From a retrospective analysis of more than 126,000 nursing home residents.

AMDA Guidelines

AMDA recommends maintenance therapy in LTC.

Read a summary of the AMDA guidelines
 
 

AMDA does not endorse any specific treatments.
 

GOLD Report Icon

The GOLD 2018 report recommends the use of long-acting bronchodilators for COPD maintenance therapy2

COPD patients in all groups may benefit from a long-acting bronchodilator

  • Inhaled therapy is preferred
  • Prescribe a long-acting bronchodilator for maintenance treatment, with a goal to manage symptoms
  • Use of short-acting bronchodilators for maintenance treatment is generally not recommended

ABCD Assessment Tool

*CAT is the intellectual property of GlaxoSmithKline. Not validated for US-based physicians.

© 2018 Global Strategy for Diagnosis, Management, and Prevention of COPD. All rights reserved. Use is by express license from the owner.


Inhalation-device education and technique training are essential to symptom management.2

On average more than two-thirds of patients make at least one error in using an inhalational device. —GOLD, 2018


GOLD does not endorse any specific treatments. The inclusion of GOLD information is not an endorsement of nebulized BROVANA® (arformoterol tartrate) Inhalation Solution.

AMDA=AMDA-The Society for Post-Acute and Long-Term Care Medicine; COPD=chronic obstructive pulmonary disease; GOLD=Global Initiative for Chronic Obstructive Lung Disease; LTC=long-term care; PA=post-acute.

NEXT: USING BROVANA IN LONG-TERM CARE 

AMDA recommends that most LTC residents with COPD should be treated with long-acting maintenance bronchodilators1*

AMDA Recommendation Table

Used by permission. Further reproduction and/or distribution not permitted without written permission from AMDA. Sunovion has derived this information, with permission from AMDA, from the AMDA Clinical Practice Guideline (CPG) on COPD. Sunovion had no involvement in the preparation of the CPG.


Bronchodilators, especially the long-acting forms, are underutilized in PA/LTC.§ —AMDA, 2016


*AMDA–The Society for Post-Acute Care and Long-Term Medicine does not endorse any specific treatments.
Quality of evidence ratings defined as High=at least 1 randomized controlled trial OR 3 pre/post interventions or other prospective interventions or 3 well-structured, relevant observational studies; Moderate=studies that use well-tested methods to make comparisons in a fair way, but where the results leave room for uncertainty (eg, because of the size of the study, losses to follow-up, or the method used for selecting groups for comparison); Low=studies in which the results are doubtful because the study design does not guarantee that fair comparisons can be made.
Strength of recommendation defined as Strong=benefits clearly outweigh risks; Weak=benefits are balanced with risks; Insufficient=evidence is inadequate to make a recommendation.
§From a retrospective analysis of more than 126,000 nursing home residents.

AMDA Guidelines

AMDA recommends maintenance therapy in LTC.

Read a summary of the AMDA guidelines
 

AMDA does not endorse any specific treatments.


The GOLD 2018 report recommends the use of long-acting bronchodilators for COPD maintenance therapy2

COPD patients in all groups may benefit from a long-acting bronchodilator

  • Inhaled therapy is preferred
  • Prescribe a long-acting bronchodilator for maintenance treatment, with a goal to manage symptoms
  • Use of short-acting bronchodilators for maintenance treatment is generally not recommended

ABCD Assessment Tool

*CAT is the intellectual property of GlaxoSmithKline. Not validated for US-based physicians.

© 2018 Global Strategy for Diagnosis, Management, and Prevention of COPD. All rights reserved. Use is by express license from the owner.


Inhalation-device education and technique training are essential to symptom management.2

On average more than two-thirds of patients make at least one error in using an inhalational device. —GOLD, 2018


GOLD does not endorse any specific treatments. The inclusion of GOLD information is not an endorsement of nebulized BROVANA® (arformoterol tartrate) Inhalation Solution.

AMDA=AMDA-The Society for Post-Acute and Long-Term Care Medicine; COPD=chronic obstructive pulmonary disease; GOLD=Global Initiative for Chronic Obstructive Lung Disease; LTC=long-term care; PA=post-acute.

NEXT: USING BROVANA IN LONG-TERM CARE 


References:
1. AMDA—The Society for Post-Acute and Long-Term Care Medicine. COPD Management in the Post-Acute and Long-Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA; 2016.
2. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2018 report. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2018:1-123. 

Important Safety Information & Indication

Important Safety Information

WARNING: ASTHMA-RELATED DEATH

Long-acting beta2-adrenergic agonists (LABAs) increase the risk of asthma-related death. Data from a large placebo-controlled US study that compared the safety of another LABA (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol is considered a class effect of LABAs, including arformoterol, the active ingredient in BROVANA.

The safety and efficacy of BROVANA in patients with asthma have not been established. BROVANA is not indicated for the treatment of asthma.


All LABAs, including BROVANA, are contraindicated in patients with asthma without use of a long-term asthma control medication; BROVANA is also contraindicated in patients with a history of hypersensitivity to arformoterol, racemic formoterol or to any of the ingredients. 

BROVANA should not be initiated in patients with acutely deteriorating COPD or potentially life-threatening episodes of COPD, or used as rescue therapy for acute episodes of bronchospasm. Acute symptoms should be treated with an inhaled short-acting beta2-agonist.

BROVANA should not be used more often, at higher doses than recommended, or in conjunction with other medications containing LABAs as an overdose may result. Patients who have been taking inhaled short-acting beta2-agonists on a regular basis should be instructed to discontinue their regular use and to use them only for symptomatic relief for acute respiratory symptoms. Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs. Patients using BROVANA should not use another medicine containing a LABA for any reason.

Immediate hypersensitivity reactions may occur with BROVANA. If signs occur, discontinue immediately and institute alternative therapy.

As with other inhaled beta2-agonists, BROVANA can produce paradoxical bronchospasm that may be life-threatening. If paradoxical bronchospasm occurs, BROVANA should be discontinued immediately and alternative therapy instituted.

BROVANA, like other beta2-agonists, can produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, systolic or diastolic blood pressure, and/or symptoms. BROVANA should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension. Beta2-adrenergic agonists may produce significant hypokalemia in some patients.

As with other beta2-agonists, BROVANA, should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors, tricyclic antidepressants, or drugs known to prolong the QTc interval because these agents may potentiate the action of adrenergic agonists on the cardiovascular system.

As with other beta2-agonists, BROVANA should be used with caution in patients treated with additional adrenergic drugs, non-potassium-sparing diuretics, and beta-blockers.

BROVANA, like all medicines containing sympathomimetic amines, should be used with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, and in patients who are unusually responsive to sympathomimetic amines.

Overall efficacy of BROVANA was maintained throughout the 12-week trial duration. Some tolerance to the bronchodilator effect of BROVANA was observed after 6 weeks of dosing (at the end of the dosing interval), although the FEV1 improvement remained statistically significant. This was not accompanied by other clinical manifestations of tolerance.

The five most common adverse events reported with frequency ≥2% in patients taking BROVANA, and occurring more frequently than in patients taking placebo, were pain (8% vs 5%), chest pain (7% vs 6%), back pain (6% vs 2%), diarrhea (6% vs 4%), and sinusitis (5% vs 4%).

BROVANA should not be swallowed as the intended effects on the lungs will not be obtained.  BROVANA is only for oral inhalation via a standard jet nebulizer connected to an air compressor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For additional information, please see the full Prescribing Information including BOXED WARNING, and Medication Guide for BROVANA (arformoterol tartrate) Inhalation Solution, at www.sunovionprofile.com/brovana.

Indication

BROVANA® (arformoterol tartrate) Inhalation Solution is a long-acting beta2 -adrenergic agonist (LABA) indicated for the long-term, twice-daily (morning and evening) maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema. BROVANA is for use by nebulization only.

Important limitations: BROVANA is not indicated to treat acute deteriorations of COPD and is not indicated to treat asthma.