What is the best treatment for chronic bronchitis (Chronic Obstructive Pulmonary Disease, COPD)?

From the Guidelines

The most effective treatment for chronic bronchitis, particularly in patients with frequent exacerbations, involves the use of a long-acting muscarinic antagonist (LAMA) as preferred monotherapy, with escalation to a LAMA/LABA combination over a LABA/ICS combination due to increased efficacy and concerns regarding pneumonia risk associated with ICS, as recommended by the 2018 GOLD report 1.

Treatment Approach

The treatment of chronic bronchitis should be tailored to the individual's symptoms and severity, focusing on reducing symptoms, improving quality of life, and minimizing the risk of exacerbations. Key components include:

• Smoking cessation to halt disease progression
• Bronchodilators such as LAMA (e.g., tiotropium) for symptom control
• Consideration of LABA/ICS for patients with a high symptom burden and frequent exacerbations, despite the potential increased risk of pneumonia
• Addition of roflumilast for patients with chronic bronchitis and frequent exacerbations, especially if FEV1 < 50% predicted 1
• Pulmonary rehabilitation to improve exercise capacity and quality of life
• Oxygen therapy for patients with low blood oxygen levels
• Vaccinations (influenza and pneumococcal) to prevent respiratory infections

Management of Exacerbations

For acute exacerbations, treatment may include:

• Antibiotics (e.g., azithromycin or amoxicillin-clavulanate) if bacterial infection is suspected
• Consideration of macrolides (e.g., azithromycin) for prevention of exacerbations in former smokers who are 65 years or older on an optimized regimen 1

Additional Considerations

• Staying hydrated to thin mucus secretions
• Annual review and adjustment of treatment as necessary to optimize symptom control and minimize exacerbations
• Consideration of triple therapy (LABA/LAMA/ICS) for patients with severe symptoms and frequent exacerbations, as supported by the 2018 GOLD report 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. The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart.

The best treatment for chronic bronchitis is Wixela Inhub 250/50, which is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema 2.

• The recommended dosage is 1 inhalation of Wixela Inhub 250/50 twice daily, approximately 12 hours apart.
• Alternatively, STIOLTO RESPIMAT is also indicated for long-term, once-daily maintenance treatment of patients with COPD, including chronic bronchitis and/or emphysema 3.
• The recommended dosage of STIOLTO RESPIMAT is two inhalations once-daily at the same time of the day.

From the Research

Treatment Options for Chronic Bronchitis

• Bronchodilators are still the most effective drugs for controlling the symptoms of chronic obstructive pulmonary disease (COPD) 4
• The combination of salmeterol and tiotropium together with fluticasone is more effective in patients with moderate-to-severe COPD than either of the 2 bronchodilators administered alone 4
• Interventional bronchoscopic procedures, such as metered cryospray and bronchial rheoplasty, offer novel therapeutic approaches to chronic bronchitis 5
• Targeted lung denervation aims to reduce parasympathetic overactivity, which may drive mucus hypersecretion 5

Medication Combinations

• The combination of a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA) is recommended for the treatment of stable COPD 6
• LAMA+LABA therapy probably holds similar benefits to LABA+ICS for exacerbations and quality of life, but offers a larger improvement in FEV1 and a slightly lower risk of pneumonia 6
• The combination of β2-adrenergic receptor agonists and anticholinergics has been shown to provide superior bronchodilatory effect than either agent alone 7

Other Treatment Approaches

• Antimicrobial agents and vaccines may have both prophylactic and therapeutic roles in the management of chronic bronchitis 8
• Bronchodilator combination therapy, including the use of long-acting bronchodilators, is effective and well tolerated for the management of patients with stable COPD 7