From the Guidelines
For patients with COPD, a single inhaler dual therapy LABD (long-acting beta-agonist) is recommended for those with moderate to severe dyspnea and/or poor health status. This recommendation is based on the most recent and highest quality study, the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1. The guideline suggests that LABD maintenance therapy should be used in all symptomatic patients with COPD confirmed by spirometry.
For patients with persistent moderate to severe dyspnea and/or poor health status despite treatment with single inhaler dual therapy, a step up to single-inhaler triple therapy is recommended. The choice of inhaler device, such as a metered-dose inhaler, dry powder inhaler, or soft mist inhaler, should be based on the patient's ability to use it correctly, as proper technique is crucial for medication effectiveness.
Key points to consider when selecting an inhaler for COPD patients include:
- Disease severity and symptoms
- Need for combination therapy, such as LABA+LAMA or LABA+inhaled corticosteroid combinations
- Patient's ability to use the inhaler device correctly
- Potential for exacerbations and need for triple therapy with LABA+LAMA+ICS. The 2023 Canadian Thoracic Society guideline 1 provides evidence-based recommendations for the pharmacotherapy management of stable COPD, with a focus on alleviating symptoms, preventing exacerbations, and reducing mortality.
From the FDA Drug Label
2.2 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.
For a patient with COPD, the recommended inhaler is Wixela Inhub® 250/50, to be administered as 1 inhalation twice daily, approximately 12 hours apart 2.
- The dosage is not to be exceeded, as some patients may experience adverse effects with higher doses of salmeterol.
- If shortness of breath occurs between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief.
From the Research
Treatment Options for COPD
The treatment of Chronic Obstructive Pulmonary Disease (COPD) often involves the use of inhalers, which can contain various medications such as long-acting beta2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and inhaled corticosteroids (ICS).
- LABA/LAMA Combination: This combination is commonly used for the treatment of COPD, as it provides bronchodilation and can help improve lung function and reduce symptoms 3, 4.
- LABA/ICS Combination: This combination is also used, particularly in patients with a history of frequent or severe exacerbations, or those with high blood eosinophil counts 5, 3.
- Triple Therapy (ICS/LABA/LAMA): For patients with persistent symptoms or frequent exacerbations, triple therapy may be considered, as it has been shown to reduce the rate of moderate-to-severe COPD exacerbations and improve health-related quality of life 6, 7.
Key Considerations
When selecting an inhaler for a patient with COPD, several factors should be considered, including:
- Symptom Severity: The severity of symptoms, such as dyspnea and cough, can influence the choice of medication.
- Exacerbation History: Patients with a history of frequent or severe exacerbations may benefit from triple therapy or a LABA/ICS combination.
- Blood Eosinophil Counts: Patients with high blood eosinophil counts may benefit from the addition of an ICS to their treatment regimen.
- Side Effects: The potential side effects of each medication, such as pneumonia with ICS use, should be considered when making treatment decisions 6, 3.