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

From the Guidelines

COPD exacerbation should be treated with a combination of short-acting bronchodilators, oral corticosteroids, and antibiotics, if indicated, to minimize morbidity, mortality, and improve quality of life. The treatment approach should be based on the severity of the exacerbation and patient-specific factors, such as the presence of bacterial infection or respiratory failure.

Key Components of Treatment

• Short-acting bronchodilators, such as albuterol, should be used as needed to relieve bronchospasm and improve lung function 1.
• Oral corticosteroids, such as prednisone, should be used for a short course (5-7 days) to reduce airway inflammation and improve symptoms 1.
• Antibiotics, such as azithromycin, should be used if bacterial infection is suspected or confirmed, to reduce the risk of treatment failure and hospitalization 1.

Additional Considerations

• Noninvasive mechanical ventilation (NIV) should be considered for patients with severe exacerbations and respiratory failure, as it can improve gas exchange and reduce the need for intubation 1.
• Pulmonary rehabilitation should be initiated after hospital discharge to improve exercise tolerance and reduce the risk of future exacerbations 1.
• Patients should be followed up with their healthcare provider within 1-2 weeks after the acute phase to review proper inhaler technique, optimize maintenance medications, and address risk factors like smoking.

Prevention of Future Exacerbations

• Adhering to maintenance medications, such as long-acting bronchodilators and inhaled corticosteroids, can help reduce the risk of future exacerbations 1.
• Getting vaccinated against respiratory infections, such as influenza and pneumococcal disease, can also help prevent future exacerbations 1.
• Avoiding triggers, such as tobacco smoke and air pollution, and promptly treating respiratory infections can also help reduce the risk of future exacerbations 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

COPD Exacerbation Management

• 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
• Treatment guidelines recommend the use of inhaled long-acting bronchodilators to alleviate symptoms and reduce the risk of exacerbations in patients with moderate-to-very-severe COPD 4

Bronchodilator Therapy

• Tiotropium is more effective than salmeterol in preventing exacerbations in patients with moderate-to-very-severe COPD 4, 5
• The combination of salmeterol and tiotropium is more effective in improving lung function than either of the two bronchodilators administered alone 6, 7
• Treatment with tiotropium increases the time to the first exacerbation and reduces the annual number of moderate or severe exacerbations 4

Respiratory Care Management

• Targeted O2 therapy improves outcomes and should be titrated to an SpO2 of 88-92% 3
• Noninvasive ventilation (NIV) is standard therapy for patients who present with COPD exacerbation and is supported by clinical practice guidelines 3
• Management of auto-PEEP is the priority in mechanically ventilated patients with COPD, achieved by reducing airway resistance and decreasing minute ventilation 3