Goodfellow Gems - an educational resource for FPs
WONCA is pleased to announce a new partnership with the Goodfellow Unit of the University of Auckland in New Zealand. As a result we will be promoting an educational resource "GoodFellow Gems" which are produced by the Goodfellow Unit.
Goodfellow Gems are chosen by the Goodfellow Unit director Dr Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice. The Goodfellow Unit owns the copyright of the Gems.
Two examples of Goodfellow Gems are listed below. All "Gems" listed on the WONCA website link to the Goodfellow Unit website where the complete "Gem" can be read.
WONCA and the Goodfellow Unit hope you enjoy this new initiative.
All Goodfellow Gems
GEM: LAMA/LABA better and safer than ICS/LABA for COPD
A trial with COPD patients with a history of at least one exacerbation in the past year found a LABA indacaterol (110 μg) plus the LAMA glycopyrronium (50 μg) once daily versus the LABA salmeterol (50 μg) plus the inhaled glucocorticoid fluticasone (ICS) (500 μg) twice daily was associated with an 11% reduction in exacerbations (3.59 vs. 4.03 p = 0.003).1 Adverse events and deaths were similar.
Prof John Kolbe comments “the advice that LAMA (+/- LABA) is the preferred treatment for most COPD patients2 is supported by this study, despite the fact that the study population was that which other guidelines recommend be treated with inhaled corticosteroids (ICS). There is likely to be a group who respond to ICS (? a long Hx of asthma) but responses were independent of the baseline blood eosinophil count. Studies are underway to identify such a sub-group.
This is further evidence of the increased rate of pneumonia in COPD patients using ICS 3.2% vs 4.8%.
This Gem has been checked by Professor John Kolbe a respiratory physician at Auckland City Hospital.
References available here
GEM : Sodium and potassium issues with blood pressure medication
A recent Alberta Tools for Practice article reviewed the literature on how low can the potassium and sodium go with commonly prescribed blood pressure medications?1
They determined that moderate hyponatremia (Na <130 mmol/L) and hypokalemia (K <3.2 mmol/L) each occur in ~4% of thiazide users, and hyperkalemia (K >5.4 mmol/L) occurs in 4% of ACE inhibitor (and angiotensin receptor blocker) users. Limited evidence suggests checking electrolytes in the first 2–4 weeks after starting, and again after increasing doses of these agents, and at least annually thereafter.
Reference available here