Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
ReplyLetters

Response

Alan Kaplan
Canadian Family Physician August 2008, 54 (8) 1110-1111;
Alan Kaplan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

I thank Dr Beever for his response to the article on the latest chronic obstructive pulmonary disease (COPD) guidelines. He is absolutely correct that the 400/12 μg budesonide-formoterol inhaler is currently not available in Canada. In addition, he is correct about the current lack of official coverage for this drug for COPD in Canada. There are randomized controlled trials showing the efficacy of this drug in moderate to severe COPD. Therefore, our recommendations are evidence-based, in spite of the current position of Health Canada. This medication is indicated and available in many other countries. We did have discussions about whether or not we should include this medication for the reasons that Dr Beever stated. We decided to be inclusive and not exclusive, and therefore added the information as per its current use in other markets.

For any inhaled device, and regardless of stage of disease, it is essential to assess each patient’s technique with that device regularly during visits to the clinic and the pharmacy. Inadequate inspiratory flow rate is only one possible problem that reduces the effectiveness of the delivery of medications to the lungs.

I am regularly asked how those who have severe lung disease can use dry powder inhalers and whether or not they can create the proper inspiratory flow. Both asthma and COPD are obstructed airway diseases, and the issue with those diseases is blowing air out (ie, expiratory flow decrease). A peak inspiratory flow of 30 L/min has been shown to be sufficient in all conditions of concern, such as childhood asthma, acute severe asthma, and COPD, including severe exacerbations.1 Therefore, inspiratory pressures are quite sufficient to allow activation of all dry powder products except in the agonal stages when assisted respiration would be necessary.

  • Copyright© the College of Family Physicians of Canada

Reference

  1. ↵
    SelroosOBorgströmLIngelfJPerformance of turbuhaler in patients with acute airway obstruction and COPD, and in children with asthmaTreat Resp Med20065530515
    OpenUrl
PreviousNext
Back to top

In this issue

Canadian Family Physician: 54 (8)
Canadian Family Physician
Vol. 54, Issue 8
1 Aug 2008
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Response
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Response
Alan Kaplan
Canadian Family Physician Aug 2008, 54 (8) 1110-1111;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Response
Alan Kaplan
Canadian Family Physician Aug 2008, 54 (8) 1110-1111;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Reference
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Water for weight loss
  • Head-to-head IUS comparison needed
  • Clarifying MAID eligibility
Show more Letters

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2023 by The College of Family Physicians of Canada

Powered by HighWire