What is the treatment for severe Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

The treatment for severe Chronic Obstructive Pulmonary Disease (COPD) should prioritize a comprehensive approach including medications, oxygen therapy, pulmonary rehabilitation, and sometimes surgical interventions, as recommended by the most recent guidelines 1. The cornerstone of pharmacological management for severe COPD involves long-acting bronchodilators, including long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs), which are often combined with inhaled corticosteroids in triple therapy regimens 1.

• Long-acting beta-agonists (LABAs) like salmeterol (50mcg twice daily) or formoterol (12mcg twice daily)
• Long-acting muscarinic antagonists (LAMAs) such as tiotropium (18mcg once daily)
• Inhaled corticosteroids like fluticasone (250-500mcg twice daily) For acute exacerbations, short courses of oral corticosteroids (prednisone 40mg daily for 5 days) and antibiotics may be necessary, as supported by previous guidelines 1. Long-term oxygen therapy is prescribed when resting oxygen saturation falls below 88%, typically starting at 2-3 liters per minute and adjusted to maintain saturations above 90%, as recommended by the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1. Pulmonary rehabilitation programs lasting 6-12 weeks help improve exercise capacity and quality of life, and should be considered for patients with severe COPD, as suggested by the management of stable chronic obstructive pulmonary disease review 1. In selected patients, surgical options like lung volume reduction surgery or lung transplantation may be considered, as indicated by the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1. These treatments work by reducing airway inflammation, improving bronchodilation, addressing hypoxemia, and enhancing respiratory muscle function, collectively aiming to reduce symptoms, prevent exacerbations, and slow disease progression in severe COPD.

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.

The treatment for severe Chronic Obstructive Pulmonary Disease (COPD) is Wixela Inhub® 250/50 twice daily, which is indicated for the maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema, and to reduce exacerbations of COPD in patients with a history of exacerbations 2.

• The recommended dosage 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.

From the Research

Treatment for Severe COPD

The treatment for severe Chronic Obstructive Pulmonary Disease (COPD) typically involves a combination of medications and lifestyle changes.

• Medications:
  • Long-acting beta2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are commonly used to improve lung function and reduce symptoms 3.
  • Inhaled corticosteroids (ICS) may be added to LABA/LAMA combination therapy for patients with a history of exacerbations 4, 5.
  • Triple therapy, which includes ICS, LABA, and LAMA, may be effective in reducing exacerbations and improving health-related quality of life in patients with severe COPD 4, 5.
• Lifestyle Changes:
  • Quitting smoking is essential for slowing disease progression and improving symptoms.
  • Regular exercise, such as pulmonary rehabilitation, can help improve lung function and overall health.
  • A healthy diet and maintaining a healthy weight can also help manage COPD symptoms.

Benefits and Risks of Triple Therapy

Triple therapy may have several benefits, including:

• Reduced rates of moderate-to-severe COPD exacerbations 4
• Improved health-related quality of life 4, 5
• Reduced risk of all-cause mortality 4

However, triple therapy may also increase the risk of pneumonia as a serious adverse event 4.

Guideline Recommendations

Guideline recommendations for the treatment of severe COPD vary, but most recommend the use of LABA/LAMA combination therapy as first-line treatment 6, 3. The American Thoracic Society recommends triple therapy with ICS/LABA/LAMA for patients with COPD and dyspnea or exercise intolerance who have experienced one or more exacerbations in the past year 6.