From the Guidelines
For a patient with severe COPD and a CAT score of 18, the first-line treatment is a combination of a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), often referred to as LABA/LAMA dual therapy. This approach is supported by the most recent and highest quality study, which recommends LABA/LAMA dual therapy as the first-line treatment for patients with severe COPD 1. Specific medication options include combinations such as umeclidinium/vilanterol (Anoro Ellipta), tiotropium/olodaterol (Stiolto Respimat), or glycopyrrolate/formoterol (Bevespi Aerosphere), typically administered once or twice daily via inhalers.
Some key points to consider when treating a patient with severe COPD and a CAT score of 18 include:
- The patient's high CAT score indicates a significant symptom burden, justifying more intensive therapy to improve quality of life and functional capacity.
- LABA/LAMA dual therapy has been shown to improve lung function, reduce symptoms, and decrease exacerbation frequency in patients with severe COPD 1.
- If symptoms persist or exacerbations occur despite dual bronchodilator therapy, adding an inhaled corticosteroid (ICS) to create triple therapy may be necessary, although this should be done with caution due to the increased risk of pneumonia associated with ICS use 1.
- Patients should also receive pneumococcal and annual influenza vaccinations, pulmonary rehabilitation if available, and smoking cessation support if applicable.
- Supplemental oxygen therapy should be considered if the patient has resting hypoxemia (SpO2 < 88%).
Overall, the goal of treatment for a patient with severe COPD and a CAT score of 18 is to improve quality of life, reduce symptoms, and decrease exacerbation frequency, while also minimizing the risk of adverse events associated with treatment.
From the Research
Treatment for Severe COPD
The first line treatment for a patient with severe Chronic Obstructive Pulmonary Disease (COPD), categorized as CAT (COPD Assessment Test) 18, involves the use of bronchodilators.
- The treatment options include:
- Long-acting beta(2)-agonists (LABAs) such as formoterol
- Long-acting anticholinergic agents such as tiotropium
- Combination therapy of LABAs and anticholinergic agents
Combination Therapy
Studies have shown that combination therapy with formoterol and tiotropium is more effective than monotherapy with either agent alone in improving lung function and symptoms in patients with COPD 2, 3, 4, 5.
- The combination of formoterol and tiotropium has been shown to improve forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) compared to tiotropium alone 6.
- The combination therapy has also been shown to reduce symptoms and improve quality of life in patients with COPD 2, 5.
Recommendations
Based on the available evidence, the first line treatment for a patient with severe COPD, categorized as CAT 18, could be a combination of formoterol and tiotropium 2, 3, 4, 5, 6.
- This combination therapy has been shown to be effective in improving lung function and symptoms in patients with COPD, and is a recommended treatment option according to various guidelines.