What is Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

COPD management should prioritize a comprehensive approach including pharmacological and nonpharmacological treatments to improve symptoms, health status, and prevent acute exacerbations, as recommended by the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1.

Key Components of COPD Management

• Confirming a diagnosis of COPD with spirometry
• Evaluating symptom burden, health status, and risk of exacerbations over time
• Implementing pharmacological treatments such as bronchodilators and inhaled corticosteroids
• Implementing nonpharmacological interventions such as smoking cessation counseling, vaccinations, self-management education, and pulmonary rehabilitation

Pharmacological Treatment

• Bronchodilators as first-line therapy, with short-acting beta-agonists (SABAs) like albuterol for rescue and long-acting bronchodilators like tiotropium (Spiriva) or salmeterol (Serevent) for maintenance
• Inhaled corticosteroids such as fluticasone may be added for patients with frequent exacerbations, often in combination inhalers like Advair (fluticasone/salmeterol) or Symbicort (budesonide/formoterol)

Nonpharmacological Interventions

• Smoking cessation counseling and treatment, including nicotine replacement therapy, varenicline (Chantix), or bupropion (Zyban)
• Regular vaccinations against influenza and pneumococcal disease
• Pulmonary rehabilitation to improve exercise capacity and quality of life

Importance of Early Intervention

• Early intervention can slow disease progression and improve health outcomes, as highlighted in the global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report 1
• Regular monitoring and evaluation of symptom burden, health status, and risk of exacerbations can help guide treatment decisions and improve patient outcomes.

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. Wixela Inhub® 250/50 is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations Wixela Inhub® 250/50 twice daily is the only approved dosage for the treatment of COPD because an efficacy advantage of the higher strength Wixela Inhub® 500/50 over Wixela Inhub® 250/50 has not been demonstrated.

COPD Treatment: Wixela Inhub 250/50 is indicated for the twice-daily maintenance treatment of airflow obstruction in patients with COPD.

• Key Points:
  • Maintenance treatment of airflow obstruction
  • Reduction of exacerbations in patients with a history of exacerbations
  • Only approved dosage for COPD treatment is 250/50 twice daily 2

From the Research

COPD Treatment Options

• The addition of fluticasone/salmeterol to tiotropium in patients with moderate to severe COPD has been shown to improve lung function indices, including AM pre-dose FEV(1) and reduce rescue albuterol use 3.
• Combination therapy with inhaled salmeterol/fluticasone and tiotropium has been found to reduce the frequency of acute episodes of symptom exacerbation and improve lung function and health status in COPD patients 4.

Smoking Cessation in COPD

• Smoking cessation is the most effective strategy for slowing down the progression of COPD and reducing mortality in patients with diagnosed COPD who continue to smoke 5.
• A combination of counseling and pharmacotherapy, including nicotine replacement therapy (NRT), bupropion, and varenicline, has been shown to be effective in promoting smoking cessation and sustained abstinence in smokers with COPD 6, 7, 5.
• Counseling should be tailored to the individual patient, taking into account their diagnosis and motivation to quit, and may include explanation of the direct relationship between smoking and COPD, encouragement to quit, and use of spirometry and measurements of CO as motivational tools 7.

Pharmacological Interventions for COPD

• Three types of pharmacological treatments have been proven to be safe and effective for smoking cessation in COPD smokers: NRT, bupropion, and varenicline 6.
• The use of these medications, single or in combination, at standard doses or at high doses, for 8-12 weeks or for more than 6-12 months, has been shown to help COPD smokers quit 6.
• Electronic cigarettes, which deliver vaporized nicotine without most of the noxious components in the smoke from burning tobacco cigarettes, may also have potential efficacy as a smoking cessation aid, but their efficacy and safety require additional study 5.