What are the treatment options for Chronic Obstructive Pulmonary Disease (COPD) exacerbation?

From the Guidelines

COPD exacerbation treatment should prioritize short-acting bronchodilators, oral corticosteroids, and antibiotics when indicated, with a focus on minimizing hospitalization duration and preventing subsequent events, as recommended by the most recent guidelines 1.

Key Treatment Components

• Increased use of short-acting bronchodilators like albuterol (2-4 puffs every 4-6 hours) to alleviate bronchospasm and improve lung function 1
• Oral corticosteroids such as prednisone (40mg daily for 5 days) to reduce airway inflammation and improve symptoms 1
• Antibiotics if bacterial infection is suspected, commonly azithromycin 500mg on day 1, then 250mg daily for 4 days, or doxycycline 100mg twice daily for 5-7 days, to treat underlying infections 1

Hospitalization and Advanced Care

• Severe exacerbations may require hospitalization for oxygen therapy, nebulized bronchodilators, intravenous steroids, and possibly non-invasive ventilation to support respiratory function 1

Post-Acute Care and Prevention

• Patients should follow up with their healthcare provider within 1-2 weeks after the acute phase to review proper inhaler technique, ensure maintenance medications are optimized, and address risk factors like smoking 1
• Prevention of future exacerbations is crucial through vaccination (influenza, pneumococcal), proper use of maintenance medications, pulmonary rehabilitation, and avoiding triggers like air pollution and respiratory infections 1

From the FDA Drug Label

The 2 exacerbation trials with fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg were identical trials designed to evaluate the effect of fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg and salmeterol 50 mcg, each given twice daily, on exacerbations of COPD over a 12-month period In both trials, treatment with fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg resulted in a significantly lower annual rate of moderate/severe COPD exacerbations compared with salmeterol (30.5% reduction [95% CI: 17.0,41.8], P< 0.001) in the first trial and (30.4% reduction [95% CI: 16.9,41.7], P< 0. 001) in the second trial. Wixela Inhub® 250/50 is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations

COPD Exacerbation Reduction:

• The use of fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg has been shown to reduce the annual rate of moderate/severe COPD exacerbations compared to salmeterol alone.
• Wixela Inhub 250/50 is indicated to reduce exacerbations of COPD in patients with a history of exacerbations.
• The reduction in exacerbations is significant, with a 30.5% reduction in one trial and a 30.4% reduction in another trial, compared to salmeterol alone 2.

From the Research

Definition and Diagnosis of COPD Exacerbation

• COPD exacerbation is characterized by an increase in symptoms such as dyspnea, cough, and sputum production that worsens over a period of 2 weeks 3
• Exacerbations are common and can be caused by various factors, including acute infections, exposure to pollutants, and the exacerbation of other respiratory diseases and non-respiratory diseases 4

Treatment of COPD Exacerbation

• Targeted O2 therapy improves outcomes and should be titrated to an SpO2 of 88-92% 3
• Inhaled short-acting bronchodilators can be provided by nebulizer, pressurized metered-dose inhaler, or dry powder inhaler 3
• Noninvasive ventilation (NIV) is standard therapy for patients who present with COPD exacerbation and is supported by clinical practice guidelines 3
• Azithromycin combined with salmeterol-fluticasone powder inhalation and tiotropium bromide inhalation have good effects for treating COPD patients with acute exacerbation of chronic bronchitis in the stable stage 5

Prevention of COPD Exacerbation

• Dual bronchodilators reduce exacerbation frequency, but in patients with continuing exacerbations, triple therapy should be considered, especially if blood eosinophils are elevated 4
• Tiotropium is more effective than salmeterol in preventing exacerbations in patients with moderate-to-very-severe COPD 6
• Combination therapy with salmeterol/fluticasone and tiotropium leads to better control of symptoms and improved lung function, with no greater risk of side-effects, as compared to salmeterol/fluticasone or tiotropium alone in the treatment of COPD 7

Management of COPD Exacerbation

• Care coordination can improve the effectiveness of care for patients with COPD exacerbation 3
• Evidence-based practices improve outcomes in patients with COPD exacerbation 3
• Patients with COPD should be extubated to NIV, and management of auto-PEEP is the priority in mechanically ventilated patients with COPD 3