From the Guidelines
The FDA has approved several medications for the management of chronic obstructive pulmonary disease (COPD), including bronchodilators, combination inhalers, and triple therapy inhalers, as recommended by the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1.
FDA Approved Medications for COPD
The following medications are approved for the management of COPD:
- Bronchodilators:
- Short-acting beta-agonists (albuterol, levalbuterol)
- Short-acting muscarinic antagonists (ipratropium)
- Long-acting beta-agonists (salmeterol, formoterol, indacaterol, olodaterol, arformoterol)
- Long-acting muscarinic antagonists (tiotropium, umeclidinium, aclidinium, glycopyrrolate)
- Combination inhalers:
- LABA/LAMA combinations (umeclidinium/vilanterol, tiotropium/olodaterol, glycopyrrolate/formoterol, glycopyrrolate/indacaterol)
- Inhaled corticosteroid/LABA combinations (fluticasone/salmeterol, budesonide/formoterol, fluticasone/vilanterol, fluticasone/formoterol)
- Triple therapy inhalers:
- ICS/LABA/LAMA (fluticasone/umeclidinium/vilanterol, budesonide/glycopyrrolate/formoterol)
- Other medications:
- Phosphodiesterase-4 inhibitors (roflumilast)
- Systemic corticosteroids
Treatment Approach
Treatment of COPD typically follows a stepwise approach based on symptom severity and exacerbation history, with the goal of alleviating symptoms, improving health status, and reducing exacerbations and mortality 1. The use of LABD maintenance therapy is recommended in all individuals who have persistent symptoms, even mild, with COPD, and LAMA/LABA dual therapy is strongly recommended over LAMA or LABA monotherapy in individuals with moderate to severe dyspnea and reduced health status.
Considerations
When selecting an inhaler device, factors such as patient inhaler technique, preference, cost/insurance coverage, and clinical course should be considered, as well as the environmental impact of the device 1. The environmental impact of metered dose inhalers (MDIs) should be taken into account, and dry-powder inhalers or emerging devices with novel propellants may be a lower carbon footprint option.
From the FDA Drug Label
ADVERSE REACTIONS Adverse reaction information concerning ipratropium bromide inhalation solution is derived from 12-week active-controlled clinical trials. Allergic-type reactions such as skin-rash, angioedema of tongue, lips and face, urticaria, laryngospasm and anaphylactic reaction have been reported. Many of the patients had a history of allergies to other drugs and/or foods All Adverse Events, from a Double-blind, Parallel, 12-week Study of patients with COPD
The FDA-approved drug for COPD mentioned in the label is:
- Ipratropium bromide inhalation solution 2 Note that the label only mentions one FDA-approved drug for COPD.
From the Research
FDA Approved Drugs for COPD
The following are some of the FDA approved drugs for COPD:
- Tiotropium bromide (Spiriva) 3
- Salmeterol (a long-acting beta(2)-adrenoceptor agonist) 4, 5
- Formeterol (a long-acting beta(2)-adrenoceptor agonist) 4, 5
- Combination therapy of a long-acting beta(2)-adrenoceptor agonist and an anticholinergic, such as Combivent (a combination of salbutamol and ipratropium bromide) 4
Long-Acting Bronchodilators
Long-acting bronchodilators are the mainstay of maintenance treatment of COPD, and can be classified into two categories:
- Long-acting beta-2 agonists (LABAs) 6
- Long-acting muscarinic antagonists (LAMAs) 6 These drugs have been shown to safely reduce the frequency of exacerbations, alleviate symptoms, and improve quality of life, exercise tolerance, and lung function of patients with COPD 6, 7
Treatment Algorithm
A treatment algorithm for the introduction of long-acting bronchodilators to patients with COPD has been proposed, which includes the use of long-acting bronchodilators early in the treatment algorithm 5 Tiotropium appears to be the best option as a first-line drug for patients with moderate-to-severe COPD because of its ability to sustain bronchodilator effect, improve quality of life, reduce COPD exacerbations, and reduce health resource usage 7