87 Evaluation of clarity of the STOPP/START criteria - SI Table SI1.1. Continued. STOPP Action Clarity rating Condition Clarity rating Explanation Clarity rating G2 Systemic corticosteroids 75% instead of inhaled corticosteroids for maintenance therapy in moderate-severe COPD 67% (unnecessary exposure to long-term side-effects of systemic corticosteroids and effective inhaled therapies are available). 75% G3 Anti-muscarinic bronchodilators (e.g. ipratropium, tiotropium) 50% with a history of narrow angle glaucoma or bladder outflow obstruction 42% (may cause urinary retention). 50% G4 Benzodiazepines 67% with acute or chronic respiratory failure i.e. pO2 < 8.0 kPa ± pCO2 > 6.5 kPa 92% (risk of exacerbation of respiratory failure). 67% H H1 Non-steroidal anti-inflammatory drug (NSAID) other than COX-2 selective agents 75% with history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent PPI or H2 antagonist 100% (risk of peptic ulcer relapse). 75% H2 NSAID 67% with severe hypertension or severe heart failure 33% (risk of exacerbation of hypertension/heart failure) 67% H3 Long-term use of NSAID (>3 months) 75% for symptom relief of osteoarthritis pain where paracetamol has not been tried 58% (simple analgesics preferable and usually as effective for pain relief) 42% 2
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