From the Guidelines
Treatment of COPD patients with chronic wheezing should start with LABD maintenance therapy, and for those with moderate to severe dyspnea and/or poor health status, single inhaler dual therapy LABD is recommended, with a step up to single-inhaler triple therapy if necessary. According to the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1, this approach focuses on alleviating symptoms, preventing exacerbations, and reducing mortality.
Key Recommendations
- LABD maintenance therapy is recommended for all symptomatic patients with COPD confirmed by spirometry
- Single inhaler dual therapy LABD is suggested for those with moderate to severe dyspnea and/or poor health status
- Single-inhaler triple therapy should be considered for patients with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy
Additional Considerations
- SITT is also suggested for all patients at high risk of AECOPD, as it reduces mortality in individuals with moderate-severe disease 1
- Targeted case-finding strategies should be implemented to identify patients who can benefit from these therapeutic options
- Regular follow-up is essential to assess treatment response and adjust therapy as needed, with the goal of improving symptoms, health status, and reducing exacerbations and mortality.
From the FDA Drug Label
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.
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.
Treatment for COPD with chronic wheezing: Salmeterol (INH) can be used to treat COPD patients with chronic wheezing, as it is indicated for the maintenance treatment of airflow obstruction in patients with COPD. The recommended dosage is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart 2.
From the Research
Treatment Options for COPD Patients with Chronic Wheezing
- The treatment of COPD patients with chronic wheezing involves the use of various inhaler medications, including long-acting beta-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and inhaled corticosteroids (ICSs) 3, 4.
- Combination therapy with LAMA and LABA (LAMA+LABA) is recommended for patients with moderate to severe COPD, as it has been shown to reduce exacerbations and improve lung function compared to LABA and ICS (LABA+ICS) combination therapy 3, 4.
- LAMA+LABA therapy has also been shown to decrease the odds of pneumonia and improve quality of life, as measured by the St. George's Respiratory Questionnaire (SGRQ), compared to LABA+ICS therapy 3, 4.
- However, the odds of all-cause death may be higher with LAMA+LABA therapy compared to LABA+ICS therapy, although the absolute risk is low 3.
- The use of triple therapy, which combines ICS, LABA, and LAMA, may be beneficial for patients with moderate to severe COPD who are at risk of exacerbations, as it has been shown to decrease the risk of exacerbations and improve lung function and health status 5.
Guideline Recommendations
- The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends initial pharmacological treatment with a LAMA or a LABA as monotherapy for most patients, or dual bronchodilator therapy (LABA/LAMA) in patients with more severe symptoms, regardless of exacerbation history 6.
- The American Thoracic Society treatment guidelines strongly recommend LABA/LAMA combination therapy over LAMA or LABA monotherapy in patients with COPD and dyspnea or exercise intolerance 6.
Evidence Quality
- The evidence for the effectiveness and safety of LAMA+LABA therapy compared to LABA+ICS therapy is based on moderate- to high-certainty evidence from heterogeneous trials with an observation period of less than one year 3, 4.
- The evidence for the effectiveness and safety of triple therapy is based on several studies, including five main fixed triple studies, which showed that triple therapy decreased the risk of exacerbations and improved lung function and health status, with a favorable benefit-to-harm ratio 5.