What are the consequences of spirometry and Beclomethasone Dipropionate (BDP) consent?

From the Guidelines

Spirometry and BDP consent are crucial in respiratory care, and failing to obtain proper consent can lead to significant consequences, including legal and ethical issues, suboptimal treatment outcomes, and compromised doctor-patient relationships. The consequences of not addressing spirometry and BDP consent properly can be far-reaching, affecting not only the patient's understanding and adherence to treatment but also the overall quality of care provided. For patients, the consequences may include receiving treatment they don't fully understand or want, experiencing unexpected side effects from BDP (such as oral thrush, hoarseness, or adrenal suppression with long-term use), or missing important diagnostic information if spirometry is declined 1.

Importance of Informed Consent

Informed consent for spirometry testing and BDP treatment involves clear communication about the purpose, benefits, risks, and alternatives to both the diagnostic test and the medication. This is essential for building trust and ensuring that patients are actively involved in their care. The evidence supports the initiation of inhaled bronchodilator treatment (anticholinergics, long-acting β-agonists, or corticosteroids) in patients who have respiratory symptoms and FEV1 less than 60% predicted 1.

Spirometry in COPD Management

Spirometry is useful to identify symptomatic patients with airflow obstruction who may benefit from pharmacotherapy. However, the spirometric decline of lung function cannot be used to measure individual long-term response to treatment due to wide intraindividual variation 1. The goals of COPD treatment are to reduce long-term lung function decline, prevent and treat exacerbations, reduce hospitalizations and mortality, relieve disabling dyspnea, and improve exercise tolerance and health-related quality of life.

BDP Treatment Considerations

For BDP specifically, patients need to understand proper inhaler technique, dosing (typically 100-400 mcg twice daily depending on severity), potential side effects, and the importance of using a spacer and rinsing the mouth after use to minimize local side effects. Ensuring proper consent and patient education can help mitigate the risks associated with BDP treatment and improve treatment outcomes.

Clinical Implications

From a clinical perspective, proceeding without informed consent may compromise the doctor-patient relationship and trust. Additionally, without proper spirometry testing, respiratory conditions may be misdiagnosed or improperly monitored, leading to suboptimal treatment outcomes. Therefore, it is essential to prioritize informed consent and patient education in the management of respiratory conditions, including the use of spirometry and BDP treatment.

From the FDA Drug Label

The long-term and systemic effects of QVAR in humans are still not fully known In particular, the effects resulting from chronic use of the agent on developmental or immunologic processes in the mouth, pharynx, trachea, and lung are unknown Rare instances of glaucoma, increased intraocular pressure, and cataracts have been reported following the inhaled administration of corticosteroids Adverse Events Reported by at Least 3% of the Patients for Either QVAR or CFC-BDP by Treatment and Daily Dose The following reporting rates of common adverse experiences are based upon four clinical trials in which 1196 Patients (671 female and 525 male adults previously treated with as-needed bronchodilators and/or inhaled corticosteroids) were treated with QVAR

The consequences of spirometry and BDP consent are not directly stated in the provided drug labels. However, potential risks associated with the use of QVAR (beclomethasone dipropionate) include:

• Systemic corticosteroid effects, such as hypercorticism and adrenal suppression
• Growth suppression in children
• Ocular effects, including glaucoma, increased intraocular pressure, and cataracts
• Hypersensitivity reactions, including urticaria, angioedema, rash, and bronchospasm
• Immunologic effects, including an increased risk of infections 2, 2, 2

From the Research

Spirometry and BDP Consent Consequences

• The consequences of spirometry and BDP (beclomethasone dipropionate) consent are closely related to the diagnosis and treatment of respiratory diseases such as COPD (chronic obstructive pulmonary disease) and asthma 3, 4, 5, 6, 7.
• Spirometry is a crucial diagnostic tool for detecting airways obstruction due to asthma or COPD, and its results can inform treatment decisions, including the use of BDP 3, 4, 7.
• BDP is an inhaled corticosteroid that can be used in combination with other medications, such as long-acting beta2-agonists (LABAs), to treat COPD 5, 6.
• The effectiveness and safety of BDP in COPD treatment are still debated, with some studies suggesting that it may not be a safe and effective alternative to other inhaled corticosteroids 6.
• The use of spirometry and BDP requires informed consent, which involves discussing the potential benefits and risks of treatment with patients, including the possibility of adverse effects such as pneumonia 6.

Diagnostic Differentiation between Asthma and COPD

• Spirometry can help differentiate between asthma and COPD, with a study showing that adding spirometry to patient history items improved the ability to differentiate between the two conditions 4.
• The study found that the area under the curve (AUC) for differentiation between asthma and COPD increased from 0.84 to 0.89 when spirometry was added to patient history items 4.
• Another study emphasized the importance of careful history taking and spirometry in distinguishing between asthma and COPD, highlighting the need for accurate diagnosis to guide proper therapy 7.

Treatment Implications

• The use of BDP in combination with LABAs may improve lung function and reduce exacerbations in COPD patients, but the evidence is not conclusive, and more research is needed to fully understand its effects 5, 6.
• A study found that BDP/LABA combination therapy was superior to fixed ICS/LABA combined therapy and LAMA tiotropium in terms of lung function and exacerbation prevention in COPD patients at risk of exacerbation 5.
• However, another study found that BDP/LABA combination therapy was associated with an increased rate of exacerbations leading to hospitalization, although this finding was debatable due to post hoc analysis showing no statistically significant difference when accounting for country-specific differences in hospitalization policies 6.