From the Guidelines
For a COPD patient with no symptoms, a long-acting muscarinic antagonist (LAMA) such as tiotropium is recommended as first-line maintenance therapy. According to the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1, LAMAs have a greater effect on exacerbation reduction compared with long-acting beta-agonists (LABAs) and decrease hospitalizations. Some key points to consider when selecting an inhaler for a COPD patient with no symptoms include:
- The use of inhaled bronchodilators, such as LAMAs, to prevent or reduce symptoms 1
- The superiority of combination therapy with LABA and LAMA in improving lung function and reducing symptoms compared with monotherapy 1
- The effectiveness of tiotropium in improving exercise performance in pulmonary rehabilitation 1 Some suitable options for LAMA inhalers include:
- Tiotropium (Spiriva) 18 mcg once daily
- Umeclidinium (Incruse Ellipta) 62.5 mcg once daily
- Glycopyrrolate (Seebri) 15.6 mcg twice daily It is essential to regularly follow up with the patient to assess lung function and monitor for symptom development, with treatment adjustments made accordingly, and to ensure proper inhaler technique to optimize medication delivery.
From the FDA Drug Label
The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart. If shortness of breath occurs in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief
For a patient with COPD and no symptoms, the recommended inhaler is Wixela Inhub® 250/50, to be used as a maintenance treatment. The dosage is 1 inhalation twice daily, approximately 12 hours apart. However, if symptoms arise, a short-acting beta2-agonist should be used for immediate relief 2.
From the Research
Treatment Options for COPD Patients with No Symptoms
- For COPD patients with no symptoms, the treatment options are focused on preventing exacerbations and improving lung function 3, 4, 5.
- Long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) are commonly used in combination for the treatment of COPD 3, 5.
- Tiotropium, a LAMA, has been shown to be safe and efficacious as a long-term, once-daily treatment for COPD, improving lung function and reducing exacerbations 4.
- Glycopyrronium, another LAMA, has been compared to tiotropium in a blinded study, demonstrating similar efficacy and safety, with a faster onset of action on Day 1 6.
Comparison of LAMA+LABA and LABA+ICS
- A systematic review compared LAMA+LABA to LABA+ICS for the treatment of stable COPD, finding that LAMA+LABA had fewer exacerbations, a larger improvement in FEV1, and a lower risk of pneumonia 7.
- The review also found that LAMA+LABA resulted in more frequent improvement in quality of life, as measured by the St. George's Respiratory Questionnaire (SGRQ) 7.
- These findings support the use of LAMA+LABA as a treatment option for COPD patients, including those with no symptoms 3, 5, 7.
Inhaler Options for COPD Patients with No Symptoms
- For COPD patients with no symptoms, a LAMA or a combination of LAMA and LABA may be prescribed as an inhaler 3, 4, 5.
- Tiotropium and glycopyrronium are examples of LAMAs that can be used as inhalers for COPD treatment 4, 6.
- The choice of inhaler will depend on the individual patient's needs and medical history, as well as the severity of their COPD 3, 5.