What is the management of Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

For the management of Chronic Obstructive Pulmonary Disease (COPD), the primary goal is to improve symptoms, slow disease progression, and enhance quality of life, as emphasized by the European Respiratory Society task force 1.

Recommendation

• For patients with mild COPD (GOLD 1), treatment typically starts with a short-acting bronchodilator such as albuterol (2.5 mg via inhalation as needed) or ipratropium (2 puffs as needed) 1.
• For patients with moderate to severe COPD (GOLD 2-3), a long-acting muscarinic antagonist (LAMA) like tiotropium (18 mcg once daily) or a long-acting beta-agonist (LABA) such as salmeterol (50 mcg twice daily) is recommended, with combination therapy considered for severe symptoms or frequent exacerbations 1.
• For patients with very severe COPD (GOLD 4) or those with a history of exacerbations, inhaled corticosteroids (ICS) may be added to LAMA and LABA therapy, such as fluticasone (250-500 mcg twice daily) 1.
• Pulmonary rehabilitation is recommended for all patients with COPD, especially those with severe symptoms, to improve exercise tolerance and quality of life, as it promotes adaptive behavior change and collaborative self-management 1.
• Vaccinations against influenza and pneumococcus are also recommended to prevent infections that can exacerbate COPD, as part of a comprehensive approach to management 1.
• Smoking cessation is crucial for all patients with COPD and should be encouraged and supported through counseling and pharmacotherapy, such as varenicline (1 mg twice daily) or bupropion (150 mg twice daily), if necessary, as it is a key preventive measure 1.
• Oxygen therapy is recommended for patients with severe resting hypoxemia (PaO2 ≤55 mmHg or SpO2 ≤88% on room air), as part of a comprehensive management plan 1.

These recommendations are based on the latest guidelines and evidence, including the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1, and the American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation 1.

From the FDA Drug Label

1. 2 Maintenance Treatment of Chronic Obstructive Pulmonary Disease Wixela Inhub® 250/50 is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema. Wixela Inhub® 250/50 is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations
2. 2 Chronic Obstructive Pulmonary Disease The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart. If shortness of breath occurs in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief

The management of Chronic Obstructive Pulmonary Disease (COPD) includes:

• Twice-daily maintenance treatment with Wixela Inhub® 250/50 to improve airflow obstruction
• Reducing exacerbations of COPD in patients with a history of exacerbations
• Using an inhaled, short-acting beta2-agonist for immediate relief if shortness of breath occurs between doses 2

From the Research

Overview of COPD Management

The management of Chronic Obstructive Pulmonary Disease (COPD) involves a comprehensive approach to improve quality of life, reduce exacerbations, and decrease mortality 3, 4, 5, 6, 7.

Diagnosis and Assessment

• COPD diagnosis is confirmed with spirometry, which is the reference standard for diagnosing and assessing the severity of COPD 3, 5.
• Disease severity is based on spirometry results and symptoms 5.

Treatment Goals and Options

• The goals of treatment are to improve quality of life, reduce exacerbations, and decrease mortality 5.
• Treatment should be guided by the severity of lung impairment, symptoms, and the amount of cough and sputum production, and how often a patient experiences an exacerbation 3.
• Pharmacological treatment options include:
  • Bronchodilators, which are the cornerstone of management 4.
  • Long-acting muscarinic antagonists and long-acting beta2 agonists, which can be used as monotherapy or in combination 5, 6.
  • Inhaled corticosteroids, which are recommended for patients with frequent exacerbations or elevated peripheral eosinophil levels 3, 4, 7.
  • Phosphodiesterase-4 inhibitors and prophylactic antibiotics, which can improve outcomes in some patients 5, 6.

Non-Pharmacological Interventions

• Pulmonary rehabilitation, which includes strength and endurance training, educational, nutritional, and psychosocial support, improves symptoms and exercise tolerance, and reduces exacerbations and hospitalizations 3, 5, 6, 7.
• Supplemental oxygen therapy, which improves survival in patients with severe resting hypoxemia or moderate resting hypoxemia and signs of tissue hypoxia 3, 5, 7.
• Lung volume reduction surgery and lung transplantation, which can improve symptoms and survival in selected patients 5, 7.

Disease Management Programs

• Multidisciplinary disease-management programs, which include follow-up appointments, aftercare, inhaler training, and patient education, can reduce hospitalizations and readmissions for patients with COPD 6.
• Timely and appropriate maintenance pharmacotherapy, particularly dual bronchodilators, can significantly reduce exacerbations in patients with COPD 6.