What is the Guideline-Directed Medical Therapy (GDMT) for Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Guideline-directed medical therapy (GDMT) for Chronic Obstructive Pulmonary Disease (COPD) should involve a comprehensive approach including long-acting muscarinic antagonists (LAMAs) and/or long-acting β2-agonists (LABAs) with or without inhaled corticosteroids (ICS), as recommended by the 2023 Canadian Thoracic Society guideline 1.

Key Components of GDMT for COPD

• Diagnosis confirmed by spirometry
• Evaluation and ongoing monitoring of dyspnea/symptom burden and risk of exacerbations
• Use of both pharmacologic and nonpharmacologic interventions to alleviate dyspnea/symptoms, improve health status, prevent acute exacerbations of COPD (AECOPD), and reduce mortality

Pharmacologic Interventions

• Long-acting bronchodilators, including LAMAs (e.g., tiotropium) and LABAs (e.g., salmeterol), as the cornerstone of maintenance therapy
• Combination therapy with both LAMA and LABA for patients with continued symptoms or frequent exacerbations
• Addition of an inhaled corticosteroid (ICS) like fluticasone for patients with severe COPD and frequent exacerbations despite dual bronchodilator therapy, particularly those with elevated eosinophil counts (≥300 cells/μL)

Non-Pharmacologic Interventions

• Pulmonary rehabilitation
• Smoking cessation
• Vaccination against influenza and pneumococcal disease
• Oxygen therapy for hypoxemic patients (PaO2 ≤55 mmHg or SaO2 ≤88%) These interventions aim to reduce airway inflammation, improve bronchodilation, and address the underlying pathophysiology of COPD, ultimately improving symptoms, health status, and quality of life while reducing morbidity and mortality 1.

From the FDA Drug Label

The safety and efficacy of STIOLTO RESPIMAT were evaluated in a clinical development program that included three dose ranging trials, two active-controlled trials, three active- and placebo-controlled trials, and one placebo-controlled trial The efficacy of STIOLTO RESPIMAT is based primarily on two 4-week dose-ranging trials in 592 COPD patients and two confirmatory active-controlled 52-week trials (Trials 1 and 2) in 5,162 COPD patients.

Guideline-Directed Medical Therapy (GDMT) for COPD includes the use of:

• Long-acting muscarinic antagonists (LAMAs), such as tiotropium
• Long-acting beta2-adrenergic agonists (LABAs), such as olodaterol
• Inhaled corticosteroids (ICS), as needed

The use of STIOLTO RESPIMAT, a combination of tiotropium and olodaterol, is supported by clinical trials as a treatment option for patients with COPD. However, the decision to use STIOLTO RESPIMAT should be based on individual patient needs and medical history, and in accordance with established treatment guidelines 2, 2, 2.

From the Research

Global Initiative for Chronic Obstructive Lung Disease (GOLD) Management

• The management of chronic obstructive pulmonary disease (COPD) is based on drug and non-drug measures, with inhaled therapies being the major issue 3.
• Inhaled bronchodilator therapy with long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) in combination is currently the mainstay of treatment for COPD 4.

Stepwise Management of COPD

• Treatment guidelines recommend the addition of inhaled corticosteroids (ICS) to LABA/LAMA only in patients with a history of frequent/severe exacerbations and high blood eosinophil counts, or in those with concomitant asthma 4.
• If symptoms are daily, such as disabling dyspnea or frequent exacerbations, daily treatment with a long-acting bronchodilator is proposed: anti-muscarinic (LAMA) or β2-agonist (LABA) 3.
• If there is no improvement, escalation to dual and then triple therapy is proposed 3.

Combination Therapy

• 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 5.
• The risk of moderate or severe COPD exacerbation was not significantly different between fluticasone furoate+umeclidinium+vilanterol (FF+UMEC+VI) and tiotropium+olodaterol (TIO+OLO) groups 6.

Short-Acting Bronchodilators

• There is a lack of guidelines for the use of short-acting bronchodilators (SABD) in people admitted to hospital for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) 7.
• The available evidence did not identify any additional benefits for participants receiving higher doses of short-acting β2-agonists compared to lower doses, or based on type of delivery method or β2-agonists used 7.